HomeMy WebLinkAbout33340-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
1110: Z-32739
Date: 11/19/07
THIS CKRTIFIES that the building
ALTERATION
Location of Property: 350 WILLOW
(HOUSE NO.)
COUnty Tax Map 1110. 473889 Section 70
POND LA
(STREET)
Block 8
SOUTHOLD
(HAMLET)
Lot 45
SUbdivision
Filed Map 1110.
Lot Il1o.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 22, 2007 pursuant to which
Building PenDi.t Il1o. 33340-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 ALTERATION/CONVERSION OF AN EXISTING GARAGE TO HABITABLE SPACE FOR
AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JAMES & PAM SMITH
(OWNER)
of the aforesaid building.
SUFFOLK COUIIITY DEPAR'D4EIIT OF BBlU.TH APPROVAL
N/A
ELBC'l'RICAL CKRTIFICATB Il1O.
3048104
10/04/07
PLUMBERS CKRTIFICATIOIII DATED
10/15/07 JAMES B. SMITH
~O.14
;tthorfzed Signature
Rev. 1/81
TOWN ~;mS~U~HOLD l r;/ri'~ ,
BUILDING DEPARTMENT /IJ~,f (I(~, '--~I
TOWN HALL '--- -/ 15::J"OY IU
765-1802 ^ ___ ;jJi U I
c I ~CiJ -. VI
'\IN F> D[p.
APPLICATION FOR CERTIFICATE OF OCCUPANCY.. ~"UrHOLD
This applicatiollmust be filled in by typewriter or il)k and submitted to the Building Department with the following:
A. For new building or new use:
I. Final survey of propeliy 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 farm).
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 2/1 0 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. Fdr existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
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 Inspector shall state the reasons tlrerefor 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 Certificate of Occupancy - $50.00
5. Temporary Celiificate of Occupancy - Residential $15.00, Commelcial $1500
Date 1(:)/, J /{')J
Old or Pre-existing Building: J (check one)
LocatiollofProperty 3~C5 W< \ \ ()~ ~f\.~ LnfI..fl ,-'i<".[Y\-b.~J c-\
House No. Street. Hamlet
Owner or Owners of Property: ~ V\n ~""]l YJrQ... ~ SV\A' t-vJ
/00 () - Dio Block OClO ~
New Construction:
Suffolk County Tax Map No 1000, Section
Lot
tJt~
Subdivision
Filed Map.
Lot:
Permit No. '3; ~ q 0 Date ofPerrnit.-Q -'1-7 - (11 Applicant:
Health Dept. Approval
Underwriters Approval
Planning Board Approval
Request for:
Temporary CeJiificate
Final Certificate:
(check one)
Fee Submitted: $
;)$
~ 7;t.f r.)
Co %. 317 3q
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 appl ication of
upon premises owned by
PAM SMITH
495 W. SHORE DR.
SOUTHOlD, NY 11971
PAMELA SMITH
495 W. SHORE DR.
SOUTHOlD, NY 11971
located at
350 WilLOW POND IN. SOUTHOlD, NY 11971
Application Number:
3048104
Certificate Number:
3048104
Block:
BDC: ns11
lot:
Building Permit:
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
First Floor, Outside,
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
October, 2007.
authority having jurisdiction, and found to be in compliance therewith on the 4th Day of
J:o!DlM QIY ~ EMing Wl!il 1m
Miseellaneous
garage converted to
living space
as built-I 999
Appliances and Accessories
Exhaust Fan
Wiring and Devices
Outlet
Fixture
Outlet
Receptacle
Switch
Dimmers
Receptacle
o
'. u~. r-<<.-'it! r'(';---..... "
Iii ....f7n? j"
. .'(! I;"~ ~/?
L "/5,' /i
, ~ lit."
" i!:I
!, \:~'! /
~'-....... r
,
F.H.P. t >
..........,..-:
14 0
14 0
17 0
11 0
9 0
3 0
I 0
Fixture
Incandescent
General Purpose
General Purpose
General Purpose
GFCI
An as built inspection, of the delineated electrical installation, determined 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.
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~ Application Number:
I Section:
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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
&I$We.-y
Upon the application of
upon premises owned by
PAM SMITH
495 W. SHORE DR.
SOUTHOLD, NY 11971
PAMELA SMITH
495 W. SHORE DR.
SOUTH OLD, NY 11971
350 WILLOW POND LN. SOUTH OLD, NY 11971
3048104
Certificate Number:
3048104
Block:
Lot:
Building permit:3 :3 3'-/0 BDC:
ns11
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
First Floor, Outside,
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 4th Day of October, 2007.
Name Ory Rate Ratin. Circuit IxIl!<
Miscellaneous
garage converted to
living space
as built-1999
Appliances and Accessories
Exhaust Fan
Wiring and Devices
Outlet
Fixture
Outlet
Receptacle
Switch
Dimmers
Receptacle
o
F.H.P.
Fixture
Incandescent
General Purpose
General Purpose
General Purpose
14 0
14 0
17 0
11 0
9 0
3 0
I 0
GFCI
An as built inspection, of the delineated electrical installation, determined 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
I of 1
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
iii irlffili'Hli1lii!lii!
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: .I D !i?:107
Building Permit No. ...:s 33 L.fO
Owner: Jl9l7u R ~/T/I
(Please print)
Plnmber:
/ij'" -',--
'(' [{......
l/r'Ji.~
111..1 ' IY fil
, " (le/ ~ I"
I certify that the solder used in the water snpply system contains les~ than4n,O of 1!YP /0 1/
....., I , I/)'
.', - IQ!
, ....... ----.; ,
"n, /
.J. /-)-I7PA, IS l(/7( '7'#
(Please print)
lead.
Sworn to before me this /-tj..Q...
day of {Jd-
, 20..tfL
,f- ;7r~
Notary PUbli~county
SUIlAN J, NAGY
Notary Publlo State of New Yor~
No. 4896735
Qualffled In Suffolk County
Commission Expires May 2011-
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.
33340 Z
Date AUGUST
22, 2007
permission is hereby granted to:
GEORGE GEDNEY
350 WILLOW POND LA
SOUTHOLD,NY 11971
for :
ALTERATION/CONVERSION OF AN EXISTING GARAGE TO HABITABLE SPACE
FOR AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
at premises located at
350 WILLOW POND LA
SOUTHOLD
County Tax Map No. 473889 Section 070
Block 0008
Lot No. 045
Fee $
200.00
22, 2007 and approved by the
pursuant to application dated AUGUST
Building Inspector to expire on FEBRU
ORIGINAL
Rev. 5/8/02
. ~a;:: Schwartz, AL4 -Architect, PLLC
=. Cutchogue, New York 11935
- ,'ip-IT.. ~ W ~ w~~
, I 'II
JcL'.2_320Ql ] U
L'U,j, Dc?..
_~~QWG.DI_5-~::)T~OlD
Phone: (631) 734 - 4185
Fax: (631) 734-2110
October 18, 2007
Southold Town Building Department
Main Road
Southold,NewYork 11971
Re: Smith House
350 Willow Pond Lane
Southold, New York
Permit# 33340
To Whom This May Concern:
I have been on site the aforementioned address to inspect the framing, rough plumbing,
pressure test for the new piping, pvc waste and vent pipes and insulation work. The
framing at the converted garage area is T'x 8"floor joists bearing on the existing slab
with a 0/1' plywood subfloor with 1" x 8" pine flooring. The 'h Bath was installed by a
licensed plumber (see Plumbing Certification) and was pressure tested. The insulation
installed is R11 in the walls and R19 in the floor with R19 at the ceiling. To the best of
my knowledge, the framing, plumbing and insulation meets or exceeds the NYS code
requirements when completed in 1999.
Please call this office if you have any questions or require additional information.
SmitimspeclCert
'33370i-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONStRUCTION
[ ] ROUGH PLBG.
[ ] 119ULATION
[ rl'FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
REMARKS:
--;DC
~fL
L
DATE If) II { 07
INSPECTOR
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~D l~srEC~lO~ UUk7E
!lD!..TI..Q.N _ ..J...' s t )
NDATION (2nd)
IGR FRAME &
,PLUMBING'
SOLATION PER N. Y.
STATE ENERGY
CODE
FINAL
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ADDrrIO~AL COMMENTS:
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_ 7~ -1- ~ TOWN OF SOUTHOLD PROPERT-rDCORD CARD
OWNER STREET.3 0
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,FORM OWNER f<; ~ '" ~,",,*,I Sf i N
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LAND
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Tillable 1
Tillable 2
fillable 3
Neadland
Swampland
Brushland
Hause Plot
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Total
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VILLAGE
DIST. SUB. LOT oL
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ACR.
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TYPE OF BUILDING I
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COMM. CB. MISC. Mkt. Value
SEAS.
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TOTAL
FARM
IMP.
DATE
REMARKS
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Value Per
Acre
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
DOCK
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\. Bldg.
dension
densian
xtension
'arch
'arch
Breezeway
;arage
Patio
O. B.
Total
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COLOR
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c 3. Bath /~ Dinette
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'u.. ),.!c. Rooms 1 st F Iocr BR.
Rooms 2nd Flocr FIN"
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Type Roof
Recreotion Rooll'
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.FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAU.
soumOLD. N.Y. 11971
TEL: 765-1802
BOARD OF REALm ...............
3 SETS OF PLANS .........~.....
SURVEy........................
CHECK .........................
SEPTIC FORM ...................
Ezanined...... k::rL.... 19q<]
Awroved........2,dy... 19~~
333lfo-e-
. '.;lcS ~..) u ~
Feramt Nb. ................
NOTIFY:
CALL 7.~.f::iY;:SY?....
MAI,h TO:....................
. r.Q.J.f~.l7.w. ~.............
.. ;:>. R :rj:~).J..J- tl. Y. in.) I. . .
G,I. (arllding Inspector)
FEB ~f 1999
ICATION FOR BUILDING PERMIT
....-
Date/:t;.k< .'t~.h...... .19J1.
INSTRUCTIONS
a. 'This applic:atioo DUSt be~etely filled in by typewriter or in ink and sulmitted to the Iklilding Inspector wil
3 sets of pl_. lIllClmIte plot plan to scale. Fee according to scheOOle.
b. Plot plan showing loc:atioo of lot a1d of buildings 00 prenises. relatiooship to adjoining prenises or pj>lic
streets or areas. a1d giving a detailed descriptioo of lay<ll1t of property DlISt be dram 00 the diagrllD .mich is part of
this applic:atioo.
c. 'The wrk covered by this applic:atioo may not be (O,,,,,,,.ced before issuance of Iklilding Fermit.
d. Upon approval of this applic:atioo. the Iklilding Inspector will issue a arllding Fermit to the applicant. Such
permit shall be kept 00 the prenises avaiUble for inspectioo thnlUl!JlOOt the wrk.
e. Nb building shall be occupied or used in .mole or in part for arty purpose wtever until a Certificate of
I)-eoll""""Y shall have been granted by the arllding Inspector.
APl'LICATIOl IS JIlBEIlY MIllE to the arllding Dq.u.lwcut for the isSlumt'P of a Iklilding Fermit pursuant to the
arllding Zooe Ordinance of the Town of Swtbold. lUffolk Coonty. New York. and other applicable IanI. OrdillllllCes or
Regu1atiOO8. for the coostnJCtioo of buildings. additiOO8 or alterations. or for RlllNal or delDlitioo. as herein
described. 'The applicant agrees to ~y with all applicable laws. ordinancea. building code. boosing code. and
regulEltiOO8. a1d to lllbit art:borized inspectors 00 prenises and in bui SBary inspectiOO8.
· (S. ~f.~~:.if.~.;,;;;.;;~~i;;).
.&9.. ~d?i:!. ?~.~.. ~':~!~./. 0.1. y. !!.? ?(.....
(Mailing address of applicant)
State Wether applicant is owner. lessee. aaent. architect. engineer.' general cootractor. electrician. plumer or builder
..... ..U.l.<)n~C.............................................................. ......................................
!lame of owner of prenises .............................................................................................
(as 00 the tax roll or latest deed)
J
If applicant is a co. poratioo. signature of <l1ly aJthorized officer.
............................................................
(!lame and title of ...""".ate officer)
Iklilders License Nb.
Plumers License 1110.
Electrici_ License Nb. .....................
Other Trade's License Nb. ....................
I. Location of land ooWich P'uvu-cd wrkwill be done..............................................................
..... .~)::Q......................1M ;/l~w. .g0./~. f.-................... ~y.-Ihf'.I.{/..................
IbJse Ibtber Street JIIInlet
CoontyTaxMapNb.llXXl Sectioo .....7.R....... Block .....9..~...... Lot ....I{.r:.......
&DIivisioo ... ............ ..... ............ ...... Filed Map Nb. ............... Lot ...............
(Ilame)
2. State existing use and ""'"'lI""""Y of prenises and intended use and occupancy of proposed coostroction:
a. Existing use and ""'"'lI""""Y .......;?.If.'~)g...E~!)J..Q~~Jli!l<:'1....,.....~{,;.;i)~Vjll~;~.....w.
S . \ C. J Q j~' '-J .' f\"."",:,::~..% .';C;\ Y".; ,
(f' 1~CV1vlI( <...Ue. ,,.., 'j.,)~i;",.:~iI..".",'afllt,"'i~lt~:i.:
b. Intended use and O<X"''J'"'ICY .............. ~~........ ZJ... ...... .,~. '.",'" ',": ~.:.,"'irl1' h'':iC#llr:tlO
3.
Mature of work (check ",id, applicable): New fuilding .......... Addition .......... Alteration . .~....
Repair............ Raooval ............. IleoDlition ............ Other Work ..................................
(Description)
Estilll1ted Cost ............ ~............ fee ..............................................
(to be paid on filing this application)
If Welling. IUliJer of dwelling .mits ..../...... lbtber of dwelling units on each floor......I........
If garage. IUliJer of cars .............~.~...................
If business. CODIercial or mixed occupancy. specify nature and extent of each type of use......................
Dimensions of existing structures. if any: Front................ Rear ............... Depth.................
llei~t ......................... lbtber of Stories ......................
Dimensions of IllIIII! structure with alterations or additions: Front............... Rear ...............
Depth.................... lIei~t .................... lb1ber of Stories....I..........
4.
5.
6.
7.
8.
Dimensions of entire new construction: Front ................ Rear ............... Depth ..............
lIei~t ......................... lbtber of Stories..................... . . '.
Size of lot: Front...1.3. .'-U.I......... Re..i .... .0.9. :TJ..... DePth..)k R.-.9.'f... .'... .
Date of Purchase ... ...... ... ......... Hare of Fonrer CW1er .Kerv:>.~.+h...l."H.dl.(:t-r.~.,ci-~t' iJ ,.
. . .. . . i ....-..
Zooe or use distnct 10 "ueb pIl!l1llseS are sstuated ............,..............................................,..
f:I. i :
,-. .
Il:Jes proposed construction violate any zoning 1..... ordinance or regulation: .... ..:':.~.............
Will lot be regraded ....... J:J.?........ Will excess fill be Il!IIOVed fran premises: ;I"'~ ~ . .
Hares of CW1er of premises .K9/.'!1t.~ 0.J~h.J:?!'Otr.'1fM1ress .?-'2:o..(,..;:ttJfM>.. ~>;'P..~.~ l'hone lb. 7./N-::.c?r/"?
u ~1 J $'",,,,+-h..,Id,'J'lY (19f(
Hare of Architect .................................... Address .............................. l'hone lb. .............
9.
10.
II.
12.
13.
14.
15.
Hare of Caltractor ................................... Address ...............................l'hone lb.
Is this property within 300 feet of a tidal wetland? * YES .......... I(). . X. . . ..
*IF YES, !D1I1IJ.D 'lllfi 'l1IIlSn,ES 8lllHIT HI\Y BE m;xpIRIlD.
PLOT DIAGRAM
locate clearly and distinctly all buildings. wther existing or proposed. and indicate all set-back dimensions
fran property lines. Give street and block IUliJer or description according to deed. and shool street nanes and indicate
uhether interior or comer lot.
~; (\~ In J:,/- p-~I1-J.
STAlK (X' N'.W ~ ffb (If- SoC;
OOJNlY (X' ......~..............
.(o/..ql''70~.q,.. y.71~a\'-fY:I.Q............. ....... .being duly sworn. deposes and says that he is the applicant
(Hare of ~ividual signi~tract)
above DlIII!d.
lie is the .................... .6c.U.~ L..............................................................
(CaItractor, agent. corporate officer. etc.)
of said owner or owners. and is duly authorized to perf0I11I or have perfonred the said work and to IIIIke and file this
application; that all statenl!Dts contained in this application are true to the best of bis knoIfledge and belief; and
that the work will be perfonred in the manner set forth in the application filed therewith.
~~~ .........
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S-o",~ljl ~y //cr-;/_i
hi r. -t m ,s . reJ" n f71cq41>~
UNDEr"'~:'=RS CERTifiCATE
r,i.QUIRED
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
, ~e-')
~V~.
'DlDE SlOIt.DtI~I_
AlAII DEVICES
AS lO'AIt nu
ioU IUlLDUlG COlI.
AP'ROVED ASIIOTED
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FEE: 7S- '. ftIPc"trI-eL-
NOIlFY' BUILDING DEMR1MI!NT .
765-1802 8 AM 10 4 PM FOR 1HE
FOUOWlNG 1NSPECJ1ONS:
" FOUlIDA1ION '. twO REQUIRED
FORIlDUIIED~...
2. ROUGH . ~G. ,,'rrn IG
4. FINAL - CONSTRUCTION MUST
BE 'COMPI.E11: FOR C.O;
ALL. coNStRUCtION .,$tW.L MEET
THE REQU!REMENTSOF .THE N.Y.
STATE CONSTRUctiON. ENERGY
COP.t:$. t40r RESPONS!liLE. FOR
DESIGN OR CONs11IU~ ERRORS
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PROVIDt' OPENINGS FOR
(.(RGEICY E$CAP( AS
REQUIRED 8Y PART. 114 Of
.. Y. STATE BUtLDlIG COOt.
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