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Home My WebLink About33520-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32949 Date: 03/25/08 THIS CERTIFIES that the building ALTERATION Location of Property: 665 (HOUSE NO.) County Tax Map No. 473889 Section 104 BROADWATERS RD (STREET) Block 12 CUTCHOGUE (HAMLET) Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 1, 2007 pursuant to which Building Permit No. 33520-Z dated NOVEMBER 8, 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 INTERIOR ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to R.J. & LYNDA J. REHM (OWNER) of the aforesaid building. SUFFOLK COUl!lTY DEPAR~ OF HEALTH APPEOVAL N/A ELECTRICAL CERTIFICATE NO. 3054072 01/07/08 PLUMBERS CERTIFICATION DATED 03/07/08 MATTITUCK PLUMBING & HEAT ~ze:!~~'- Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 -U,4 5 - ts"ll J- APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Depaliment 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 fOlm) 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. Conunercial building, industrial building, multiple residences and similar buildings and installations, a cetiificate 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) nou-conforming uses, or buildings and "pre-existiug" land uses: I. Accurate survey of property showing all propetiy lines, streets, building and unusual mtural or topographic features. 2. A properly completed application and consent to inspect sigued 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, Accessory building $25.00, Additions to accessory building $2500. Businesses $50.00. 2. CertifIcate of Occupancy on Pre-existing Building _ $100.00 3. Copy ofCeliificate of Occupancy _ $.25 4. Updated Celiificate of Occupancy - $5000 5. Temporary Certificate of Occupancy - Residential $]5.00, Commercial $15.00 Date ~.3 / ~Q g>- Old or Pre-existing Building: / Location of Propeliy 01 p-'') A ~woJer s fZl{ House No. Street Owner or Owners of Propeliy ){! U .J.- tin da... ~ ~ yY) ____ Suffolk County Tax Map No I 000, Section~t173~~9____ Block _--.C2QL~ ______. lut ~_DO ~__~ New Construction: (check one) --f!u1t1JJDt::lL!- e ~~lle( Subdi vislol1 Permit No .~ 7,6'd)()___ Date of PerlTlllJJ%L07 Fried Map Lol APPlicanl~ ffix.z~~ JI:u~~--;~s Health Dep!. Approval: _________________._ Underwriters Approval ----~----------~_..._~.. --_._~ Planning Boald Approval __________________ Request felf' Temporary Celtlfica!e _________ Final Celilfica!e v .---- Ie (check ulle) Fee Submllled $ --.d_5 - (J...~. IlfO 2. t..( LO f Edq '11 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. 33520 Z Date NOVEMBER 8, 2007 permission is hereby granted to: R & L REHM 665 BROADWATERS RD CUTCHOGUE,NY 11935 for : INTERIOR ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 665 BROADWATERS RD CUTCHOGUE County Tax Map No. 473889 Section 104 Block 0012 Lot No. 004 pursuant to application dated NOVEMBER 1, 2007 and approved by the Building Inspector to expire on MAY 8, 2009. Fee $ 200.00 !~ , Authorized Signature ORIGINAL Rev. 5/8/02 l!I~~l!I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I Located at ~ Application Number: I Section: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I l!I~'E!JE!Jfi!~ ~ ~ ~ ~ jlY!. - /) -y ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~~l!I 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 JIM SHAW ELECTRIC, INC. 530 MIDDLETON ROAD GREENPORT, N.Y. 11944 R & L REHM 665 BOARD WATERS ROAD CUTCHOGUE, NY 11935 665 BOARD WATERS ROAD CUTCHOGUE, NY 11935 3054072 Certificate Number: 3054072 Block: Building Permit: 33520Z-2007 BDC: n511 Lot: Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: :3 3SS.Q Basement, First Floor, 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 7th Day of January, 2008. Name OTY Rate Ratin. Circuit ~ Appliances and Accessories Exhaust Fan Dish Washer Panels o o 1.2 F.H.P. KW 100 Wiring and Devices Outlet Fixture Outlet Receptacle Switch Receptacle 13 0 13 0 11 0 7 0 4 0 3 0 Fixture Incandescent General Purpose General Purpose General Purpose GFCI seal I 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. Tu\~n Hail, 53095 Main Road POBox 1179 :-i__:!'~',;c: '\c\\ YOlk 11971-0959 Fax (631) 765-9502 Telephone (631) :65. 16'~~' BUILDING DEPARTMENT TOWN OF SOUTH OLD CERTIFICATION Date- -3, 7. tJj7 Butldlng Permit No 335;)0 Owner ~-c:f+ '+ L,ndtl.- (2 dm_ (Please print) Plumber {' j{j",--L -<..._~ I cer1ify that the solder used in the water supply system contains less than 2/1 0 of 1% lead j/u~,1!!f I'] 0' Sworn 10 before me this ( dJ\ of h7/i..4.-c-L 20 <" t I DENISE KING Notary Public, State of New York Registration #01 KI6041757 Qualified in S~ffolk County c () My Commission Expires Mav 15, 2-L- ;:~~ '\our\' PUbll~- County - - - 33S~ Z- - TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRucnON REMARKS: ~ [ ] ROUGH PLBG. [ ] INSULATION C>4- FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION ~ c.vvt ' , /1h .~ .>rI-/_>(b/lA }V~_ &\ ~~ dQ -vtAJ' 3~~tL- DATE 3--J-/--o!' INSPECTOR *~ }}SCJ-b L. TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUC11ON [ ] ROUGH PLBG. N INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS:~ ~~ W-rDk -I:.1J- ~ r DATE /';).. ~ (; - 0 7 INSPECTOR ~ ~ -~- -- ---- --- -~-~~ ---- ) 35;}-O 2- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ~MIN~ STRAPPING [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETAAnON REMARKS: P/VAY'-f~ ~ z>>c: DATE (?-~Lf- ~ 07 INSPECTOR ~ ~ . FIELD INSPECTION REPORT DATE ! COMMENTS IJ.l "->"C , I \}\l"J FOUNDATION (1ST) /1/ / d-- &>~ ( / / rl.J'" 'It ---------------.-------------------- ~tiiJ , AlI/ /1/ FOUNDATION (2ND) l'"l f'V / 11 { "2 ~ ~9 11-41- r7 r?l.- -.CJ '12-oK, ./":7' ,'/# ~~ (f ROUGH FRAMING & PLUMBING -- t'" ~ fC> ~-- -- ]---;~ r[----J.l-- , .-~~ ~vf 1;;;;:; (.... 01 tZ./ , N ;::I: Il:-___ ~~ ,,, / INSULATION PER N. Y. -~ .,.t:j STATE ENERGY CODE c, " 3-)/--. f .;C~ ~ c)k'~P~~"" ",1,.(. ADA '01. IA--It?- v FINAL . ADDITIONAL COMMENTS ~ ~ -- ':E ~ - -- ~' -, Vil'"l -~ o<:>:;a '--.. C>'" -- 0 2 \ gj ~ '" :I: I:' l'"l ,"C -- ':-I ~~~~~~,;,i~~E~u0! '0~" ;' Wi TOWN HALL L SOUTHOLD, NY 11971! ~'. TEL: (631) 765-1802 L---2PYV, , c FAX: (631) 765-9502 www.northfork.net/Southold/ ~ '3.5 /]V C:::. 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: " I . -J~I ~~H()' F) PERMIT NO. , ,26)7 ( i, 20 01 Examined Approved Disapproved ale Mail to: s;~ ,204 Phone:7? 5-~77;2 Expiration (UA . Bmldmg Inspector APPLICATION FOR BUILDING PERMIT Date II /1 , ,20~ 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. Pee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, jlnd 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 -!'il 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 authorized inspectors on premises and in building for necessary inspections. ~ (Signatur po. dJv,Y 789 SoclHtolcl' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises Cfrn~k ft -f+- +- !- ..wlcP <1- (j1 h ff\ (As on the tax roll or latest deed) I plicant is a corporation, signature of duly authorized officer YVlo t2..' PIUA . (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 6]tf; !!-; .~ ~q3-me I. Location of land on which proposed work will be g,on;: h 13 _'" /3iZoftd? IV IJ../&t.s I4f' House Number Street County Tax Map No.1 000 Section Subdivision lOt( C4 iUJDejU-v Hamlet Bl k I,;)..., M'tIOQi'I4ih.. A(16'l'j l/ oc ..., ... III .....t''::Il~..,. : ,.f:frwf Filed Map No. lIIal.!"i'..I"<hot ~., -'Q11tlf;. ~(i ,. {.<",; :tloj",~""" ~..,:';;; j'l/.1. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / rftk.,.' ~ . b. Intended use and occupancy / ~<~ 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Other Work Alteration X , (Description) 4. Estimated Cost :)Ill lflJo- 5. If dwelling, number of dwelling units If garage, number of cars Fee / (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 oflol: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO-X" 13. Will lot be re-graded? YES_NO:f' Will excess fill be removed from premises? YES_NO + 14. Names of Owner of premises ~ Address Phone No. Name of Architect Address Phone No Name of Contractor K'O\\! !v\OlQ..t-1-U? AddressP.o. g~ 7 ~c; Phone No. "'7 t5' - 5'77d-. 'So v -rt>o / if . 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. STATE OF NEW YORK) COUNTY OF gq$f~S: RL1YIoJa.. Mo Yi. 'Z- "Z.-O being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, ($)He is the ~kcW (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. S~m to before me this +--.:/:2 day of NcNe~ 20fl- ~{Nflra~~ ~ LIIDA P. IWIDCll.PH ffClfM1lV PUalC. _at..-.- No.01AA814111O QualIIIed -. lIulIaIk Caunlr J ,1 ~ ElopneJWy 2OJ.V MAP e)f:' PQOPEf2Ty SU12 \!E\'ED FQQ Ir-rT it i ! i-\. in (\ _..,.,Lei.;- - L I.-J L./l~, fif', -1\)1 !<:L_dl' : 8; - '010, 'V~,.. '11 Er-'':.- ',-...' 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