HomeMy WebLinkAbout33335-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32610 Date: 09/19/07
THIS CERTIFIES that the building ALTERATIONS
Location of Property: 1125 LEETON
(HOUSE NO.)
County Tax Map No. 473889 Section 59
DR
(STREET)
Block L-
SOUTHOLD
(HAMLET)
Lot 13
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 9, 2007 pursuant to which
Building Permit No. 33335-Z
dated
AUGUST 22, 2007
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" ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ROBERT & JO-ANN KALB
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
3043204
08/17/07
PLUMBERS CERTIFICATION DATED
08/21/07 GARY STAHL
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ut~ize Signature
Rev. 1/81
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Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
~
415"=-116 (
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:
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, Sw6m statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lead,
5, Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of~ode Compliance from architect or engineer responsible for the building,
6, Submit Planning Board Approval of completed site plan requirements,
R For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land nses:
I, 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 l11Spector 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 of Certificate of Occupancy - $.25
4, Updated Celiificate of Occupancy - $50,00
5, Temporary Certificate of Occupancy - Residential $15,00, Commercial $15,00[ (
Date 8/~D/O 7
~ (\
(check one)
New Construction:
Location of Property:
II -z...S-
Old or Pre-existing Building:
l-et (01-1 ~ I
House No,
Street
soc..m{ol.'\)
Hamlet
Owner or Owners of Property: ~'5'E:::-~l KA-L.:~
Suffolk County Tax Map No 1000, Section 5"\ Block
Lot /3
Subdivision
PemutNo, ?333~
U'~a-te of permit.1i~ll
Filed Map,
Lot.
13 t.L U,Ol.W\......1lJ
Applicant:
Health DepL Approval: _.
Underwriters Approval:_,__._
Planning Board Approval: ~
Fee Submitted: $
Temporary Certificate _
2~~
Final Certificate:
Request for:
(R.u.--. 730 So
c.o -e ~JCdO
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.
33335 Z
Date AUGUST
22, 2007
permission is hereby granted to:
ROBERT & JO-ANN KALB
755 RUGBY RD
BROOKLYN,NY 11230
for :
AS BUILT ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at
1125 LEETON DR
SOUTHOLD
County Tax Map No. 473889 Section 059
Block 0001
Lot No. 013
pursuant to application dated AUGUST 9, 2007 and approved by the
Building Inspector to expire on FEBRUARY 22, 2009.
Fee $
400.00
ORIGINAL
Rev. 5/8/02
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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 17th Day of August, 2007.
Name OTY ~ Ril!iIlg Qm!il Illls
Miscellaneous
~ as built -1995
~ Appliances and Accessories
~ Exhaust Fan
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BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD .oF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of
upon premises owned by
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PHIL GORMAN
PO BOX 1447
MATTITCUK, NY 11552
ROBERT KALB
1125 LEETON DR
SOUTHOLD, NY 11971
1125 LEETON DR SOUTHOLD, NY 11971
Application Number:
3043204
3043204
Certificate Number:
Section:
Block:
Lot:
Building Permit:
BDC:
n511
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Second Floor, bathroom,
o
F.H.P.
Wiring and Devices
Outlet 2 0 Fixture
Fixture 2 0 Incandescent
Outlet 3 0 General Purpose
Receptacle 2 0 General Purpose
Switch 1 0 General Purpose
Receptacle 1 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 the applicable reference standard for the estimated period of conStruction of the premises wiring system.
seal
of 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.
-'-----______~~,_'_____,_'____.::...:_C:_'_.._i.-
Town Hall, 53095 Main Road
P.O.. Box 1179
Southold, New York 11971-0959
Fax (631) 765-9502
Telephone (631) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date:
8/21/07
(
Building Permit No. "3'553S
Owner: !( of>e'1.Z:l .f:ALlS
(Please print)
Plumber 6~'1 5TI4f)L
(Please print)
lead.
I celiify that the solder used in the water supply system contains less than 2/1 0 of 1%
Sworn to before me this (). J
day of ~ , 20~
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Ha.dt. Ha.d.W-/
Notary Public, ~I k County
HAD! HACHEM rk
NotIIrY Public - S18t8 of N_ Yo
No. 01HA8087986
QU8Iffi8dlnSunolkcoun~
My Commission Expl.... Mar 03, 2011
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, .\~..'\\~. '" \ \~. \:!j\\ JAMES J. DEERKOSKI, P.E.
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.)~\ __ _ ~ 2~0 Deer Drive
l--: .', c"~O';1.-- Mattltuck, N.Y. 11952
\~=- (631) 298-7116
To: Town of Southold Building Dept.
Date: September 10, 2007
Re: Plumbing/Insulation Inspection
Robert Kalb
1125 Leeton Dr.
Southold, NY 11901
Permit #33335
To Whom It May Concern:
After a Plumbing/ Insulation inspection was performed on the above structure, it is
deemed that all work was done as per plan, and meets all state and local building codes at
the time of construction. A Pressure test was also performed on the entire plumbing
system. Any other questions please call.
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TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I!JSULATION
[ ] FRAMING I STRAPPING [;-{FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRucnoN [ ] FIRE RESISTANT PENETRATION
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REMARKS:
INSPECTOR
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FIELD INSPECTION REPORT DATE I COMMENTS \)J
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southoldl
PERMIT NO.
J~~>f-&
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Examined
,20--Y
,20.:2J.
Approved
Disapproved alc .
Mail to:
Phone:
Expiration ,~
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\\" '-~ ',9 1 \~LICATlON FOR BUILDING PERMYI
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Date
8~
2007
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INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 South old, 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
~iliori"" ;0'_" 00 _=.ruI;o !m;W;o, foc ~"=Y 'o_~, ~
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19na e 0 app leant or name, 1 a corporatiOn
('6 tJO)( /4.47, /MJ4:rrfTr/tKjAJ{
(Mailing address of applicant) I t '1'>2-.
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
~
Name of owner of premises 7la'6~\ s :ro4tJ~ K4Li:3
(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 ofJand on which proposed work will be done:
1125"' L-a LOA..) bR(~
House Number Street
;btm{O LD
Hamlet
(Name)
Lot
Lot
(3
County Tax Map NO.1 000 Section D
Subdivision
2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiQn:
a. Existing use and occupancy 5 ( pc;, L{;: .::r::;o.vv...... 72.e-s ( c> e- JJc.F""' . .
~ a~s:oe rn 1[.4:<:> lS\JLL-1" \\
b. Intended use and occupancy
5A-~
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3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
Alteration .,.---
4. Estimated Cost
lDjeOD
(Description)
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: Front
Rear
Depth
10. Date of Purchase
Name of Former Owner
II. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO /
13. Will lot be re-graded? YES_ NO J Will excess fill be removed from premises? YES_ NO .,--
14. Names of Owner of premises ~O~
Name of Architect
Name of Contractor
~
Address
Address
Address
IllS" L~ 'C)g., Phone No. 76,- 3154
Phone No
Phone No.
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 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.
18. Are there any covenants and restrictions with respect to this property? * YES_NO_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
ss:
COUNTY OF )
VI t.L14M 'Go rtJ1/ M.J being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
A6r;;z/l
(Contractor, Agent, Corporate Officer, etc.)
(S)He is the
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.
200r
Town of South old
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY lOCATION: S.C.T.M. #:
{~~ fer.1. -.b- JJ-
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
----------------------------------------------------
Item Number: (NOTE: A Check Mark ( J) for each Question is Required for a Complete Application)
Yes
No
1
----------------------------------------------------
2
3
4
5
6
7
8
9
Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site?
(This item will include all run~off created by site clearing and/or construction activities as well as all Site
Improvements and the pennanenl creation of impervious surfaces.)
Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Sulface Waterflow!
Will this Project Require any land Filling, Grading or Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel?
Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Surface?
Is there a Natural Water Course Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach?
Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
Will Driveways, Parking Areas or other ImpelVious Surfaces be Sloped to Direct Stonn-Water Run-Off
into and/or in the direction of a Town right-of-way?
Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of
any Item Within the Town Right-of-Way or Road Shoulder Area?
(This item will NOT include the Installation of Driveway Aprons.)
Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse?
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NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark In the Box, a Storm-Water, Grading,
Drainage & Erosion Control Plan Is Required and Must be Submitted for Review Prior to Issuance of Any Building Pennit!
EXEMPTION:
----------------------------------------------------
No
Yes
Does this project meet the minimum standards for classification as an Agricultural Project?
Note: If You Answered Yes to this Question. a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requiredl
----------------------------------------------------
STATE OF NEW YORK,
COUNTY OF .....5..~IK..,.............. SS
That!, ..t.().~..~.\.~....~~~.................. being duly sworn, de~oses and says that he/she is tile applicant for Pennit,
(Name of individual Signing Document)
And that he/she is the ....................A?~.....................................................................................................................
(Owner, Contractor, Agent. Corpotate Officer, etc.)
Owner and/or representative of the Owner of Owner's, and is duly authorized to perform or have performed the said work and to
make and file this application; that all statemenls contained in this application are true to the best of his knowledge and belief; and
that the work will be perfomled in the manner set forth in the application filed herewith.
Sworn to before me this;
........................9................... day of .......&~.ill:............ ,20Q.r-
Notary Pubhc: .1fJ!..J2...~.................................
FORM - 06/07
. Qualified in Sulfnl~ r.,!I!'1y
Commt~s"'" 1 'I'''''' 1f1(Jr 1'1211"
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MAP OF PROPERTY
SURVEYED FOR
J2AUL._STEWAfi1-
AT
SOUTHOLD
TD\..vN OF 9:)UTt-JOLD
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