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HomeMy WebLinkAbout33874-ZFORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33053 THIS CERTIFIES that the building ALTERATION Location of Property: 1625 CHABLIS PATH SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 51 Block 3 Lot 3.6 Subdivision Filed Map No_ Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 24, 2008 pursuant to which Building Permit No_ 33874-Z dated MAY 7, 2008 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" BASEMENT ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SCOTT & GERARDA BOGER (OWNER) of the aforesaid building. SIIFPOLR CODNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3062554 03/28/08 PLDMBSRS CERTIFICATION DATBD 05/16/06 K & K PLUMBING & HEAT .tom tho zed ignature Date: 05/28/08 Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY M~,',1 ~~~ -bo3 ~Z3 This application must be filled in by typewriter or ink and submitted to the Building Department with the following:."' \~O 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. Swom statement from plumber certifying that the solder used in system contains less than 2/10 of 1 % lead. S. 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 Apri19, 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, 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 - $.2S 4. Updated Certificate of Occupancy - $50.00 S. Temporary Certificate of Occupancy -Residential $15.00, Commercial $IS.00 2q ~y Date. ~/O J~ b New Construction: Old or Pre-ex~isst/ing /B/uilding: (check one) Location of Property: ~~ ~~ C1~,l~s. D y~J House No. Street ~ Hamlet Owner or Owners of Property: x[17/ J f'/ (~~/Ly'/~/l~`7 4~l/t-2~G~C~ Suffolk County Tax Map No 1000, Section ~ Q~' Block QOCJ nj Lot (~ . Q~ Subdivision _ Filed Map. „Lot: Permit No. 3 ~ 7'' Date of Permit. ~ 7 B8' Applicant: ~c~~~GC~A Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate O ~ Fee Submitted: $ ~ 5 c.~ ~ 3 053 ~ ~~ ~~3~~ Underwriters Approval: Final Certificate: • (check one) Applic nt ignature Town Han, 53095 Main Road P.O_ Box 1179 Southold, New York 1 1 971-0 959 BUILDING DEPARTMENT TOWN OF $OUTHOLD CERTIFICATION Fax (631) 765-9502 Telephone (631) 765-1Zm2 Date: ~ ~~~ / ~ ~ ~---- Building Permit No. 33874 Uwner Scor~r Bow (Please print) ~~-3 5 i - P Plumber T~-.~J~ ,r IL/~ci~ i ~A a ~,/ ~s (Please prim I certify that the solder used in the water supply system contains less than 2110 of 1 lead. ~f~ ~~~4=~L.~r~ /- (Plumbers Sigasture) Sworn to before me this I~ / of n 1 20~ 11 I ~C , l/~ ` U BONNIE 1. DOROSKI Notary Public, Notary Public, State Of~N~ No-QIBDGt1i932s'9af$~ Term Expires July 7, 20 ~,~ pd(?t.n+aF~. (~~ 5/.3-3(0 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 SCOTT BOGER PO BOX 163 SOUTHOLD, NY 11971 Located at 1625 CHABLIS SOUTHOLD, NY 11971 Application Number: 3062554 Section: Block: Lot: upon premises owned by SCOTT BOGER PO BOX 1603 SOUTHOLD, NY 11971 Certificate Number: Building Permit: 3062554 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: Basement, base-pond pump, 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 28th Day of March, 2008. Name ~ Rate Ratine Circuit Tvoe Miscellaneous as built 2007-certificate for finnished basement and fish pond pump Alarm and Emergency Equipment Sensor 1 0 Carbon Monoxide Sensor l 0 Smoke Appliances and Accessories Exhaust Fan 1 0 F.H.P. Wiring and Devices Outlet 20 0 Fixture Fixture 19 0 Incandescent Fixture 1 0 Flourescent Outlet 18 0 General Purpose Receptacle 15 0 General Purpose Switch 15 0 General Purpose Receptacle 1 0 GFCI seal Continued on Next Page ] of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location inckcated. 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 SCOTT BOGER SCOTT ROGER PO BOX 163 PO BOX 1603 SOUTHOLD, NY 11971 SOUTHOLD, NY 11971 Located at 1625 CHABLIS SOUTHOLD, NY 11971 Application Number: 3062554 Certificate Number: 3062554 Section: Block: Lot: Building Permit: 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: Basement, base-pond pump, 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 28th Day of March, 2008. Natne QTY Rate Ratine Circuit Tvoe 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 [he premises wiring system. seal 2 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 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. 33874 Z Date MAY 7, 2008 Permission is hereby granted to: SCOTT & GERARDA BOGER PO BOX 1603 SOUTHOLD.NY 11971 for AS BUILT ALTERATIONS TO AN EXISTING BASEMENT AS APPLIED FOR at premises located at 1625 CHABLIS PATH SOUTHOLD County Tax Map No. 473889 Section 051 Block 0003 Lot No. 003.006 pursuant to application dated APRIL 24, 2008 and approved by the Building Inspector to expire on NOVEMBER 7, 2009. Fee $ 400.00 ORIGINAL Rev. 5/8/02 ~S~R~'co~o Date ~ 1`~~do ~~~ C File # 7 ~ TOWN OF SOUTHOLD COMPLAINT REFERRAL FORM Location of Complaint: '~ as ~`~ ~i5 ~~ SCTM#5``- 3 .3l 1•/~ Property Owner: _~C ~ ~Q~. Phone l~ " ~~ 7 ~" O ~~ L~~ NATURE OF COMPLAINT: - IU ZJ fS~ 'f' rY~r ~~ ¢~y (moo-~./~ a-c.n,..21._ c Optional: Complainant: rl n I7~u M 1~viS By Phone ~ Mail In Person Address Phone: Report Taken ey: Date Referred to Code Enforcement: STfE INSPECTION REPORT/DATE: Date: ACTION/DATE: ~~Q 1~~_~'~G/J ~., ~'~~~ `~~ ~ v ~ ~~~~~ 1 ~ 6 ~s c~~_ ~.~ ~o~~Of SO(/r,~~~ ,, Q ~ ~r ~ +1~ ©+IF ~® TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATIOI ~. DATE ~ -/s- d ~ INSPECTOR 33 ~1~~- TOWN OF SOUTFIOLD BUILDING DEPT. 765.1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING /STRAPPING [ ]FIREPLACE 8~ CHIMNEY [ ]ROUGH PLBG. [ ] INSU ON [ NAL [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKS: DATE ~ INSPECTOR .~3~7~-~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING /STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCT REMARKS: [ ]ROUGH PLBG. [ ]INS TION [ FINAL f ]FIRE SAFETY INSPECTION /[ ]FIRE RESISTANT PENETRATI01 ~~ ~ ~(~ 0 ~ DATE ~ ' INSPECTOR S ~ FIELD INSPECTION REPORT ~ DATE COMMENT c~~' ~e to FOUNDATION (1ST) a ,r. y (~ ~ FOUNDATION (ZNDI ~ \\ z 0 I y ROUGH FRAMING & ~ H PLL?IvIBING ~~ 1 ~x y L~'SULATION PER N. Y. STATE ENERGY CODE - -- - ~ ~ ~~ /6 0 FINAL - ADDTTIONAL COMMENTS Q ~-- c p ~ m v ~ , ~ ~. o ~a ~ o ~ z w ~ - - I ti TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net PERMIT NO. `~3 ~~?S 4 sets of Building Plans_ Planning Board approval Survey Septic Form N.Y.S.D.E.C. Trustees Examined ry , 20 Approved / ,20 V Disapproved APR 2 4 Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: 20 I`~ ~ mlding Inspector ,, ~ , , ~; APPLICATION F R BUILDING PERMIT I 1 t , Date Z~ . zo ~~ INST UCTIONS 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 schedu`l~~ 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 commen ed before issuance of Building Permit. d. Upon approval of this application, the Building Inspector . 1 issue a Building Permit to the applicant. Such a permit shail be kept on the premises available for inspection throughout the wcsrk. 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 ma~ 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 Departm`e'nt for the issuance of a Building Petmit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, NecW fork, 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 ct?de, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections 7 ~ X . ~,. P ,i~~,_ or name, if a corporation) Q~ (~GX I~b'3 , ,Sou address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elect~ncian, plumber or builder W yV ~I~ Name of owner of premises (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. of land on which pt CNA House Number Street Hamlet County Tax Map No. 1000 Section ~ Block Lot 3 Subdivision (~~/f7/IGtYi~i/.9 v ~~CilJS Filed Map No. Lot _ ~, -- - ~ 7 be done: BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health ou,~v~0 2. State existing use and occupancy of a. Existing use and occupancy b. Intended use and occupancy T 3. Nature of work (check which applicable): New Building Addition Alteration Repair Remova] Demolition Other Work ~ASf µf~ r- 2~~cv~ (Description) 4. Estimated Cost If dwelling, number of dwelling units If garage, number of cars Fee (Tg be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Sty ~ Rear ~ 4~ Dimensions of same structure with alterations or add Depth Heig Depth Y ~ Front Rear Number of Stories 8. Dimensions of entire new construction: Front ~ Rear Depth Height Number of Stories 9. Size of lot: Front ~~~' Rear ~ ~~~ Depth ll C~ 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated Q~FS", 12. Does proposed construction violate any z/oning law ordinance or regulation? YES_ NO 13. Will lot be re-graded? YES NO V Will excess fill be removed from premises? YES NO~ 14. Names of Owner o Name of Architect Name of Contracts No. 7~~5 37`/'~ No. 15 a. Is this property within 100 feet of a tidal wetla,~d or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & L)`,E.C. PERMITS MAY BE QUIRED. b. Is this property within 300 feet of a tidal wP' and? *YES NO~ * IF YES, D.E.C. PERMITS MAY BE REQ, IRED. 16. Provide survey, to scale, with plan and distances to property lines. 17. If elevation at any point on progP(-ty is at 10 feet or below, must provide topographical data on survey. r 18. Are there any covenants hid restrictions with respect to this property? *YES NO V * IF YES, PROVIDE A C~py. STATE OF NEW YORb,"~ SS: COUNTY OF ~ ~~OT ~ ~Q~~~- being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contact) above named, (S)He is the 'Gt/~/~~/C~oh/ 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 statemen s 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 V STAN H Notary Publlc,~te of~w York ~ Sworn to before me this Qualified iri Suffolk ~ unry _~~~ day of Q~ 20Ud' Commission Expires AD 'I , 20~~_ f ~'~~ _ P otary Public Signature and intended use and occupancy of,proposed construction: OFFICE FEE: BUILDIN E ARTMENT I NOTIFY 765-1802 8 AM 0 4 PM FOR TH FOLLOWING INS E REOUIREDt - 1. FOUNDATION FOR POURED A T C__'RETE ~~ MING & PLUMBIN G 2. ROUGH • FR 3. INSULATION "RUCTION MUS><i CONS } 4. FINAL • BE COMPLET OR C.O. ~ SHALL M T THE ALL CONSTRU TI F HE CODES F NEW REQUIREMENT RESPONSI~ E FOR YORK STATE. N N UCTION ~E RORS. DESIGN OR C AS NOTED K ALL CONSTRUCTION SHALL I , + MEET THE REQUIREMENTS OF THE ~ggCER'~~ CODES OF NE~V YORK STATE. r~pEE1~ EQNFED 1"~ • n Iy~ J l Zp o ~- CONjPLY NE`s ~ '^,u AS RE~'~,R li ---- __- _ _ .C i9 iirs. t ; ---- ---- - r ,I i i Ply ^Ag! ~ ~ i ,, ~ ~~ y ,, _---- - S OF r. °I CODES ~s- sy ~ i t "M~. IONS OF h ^~~^ti CPU TEES S~ ~~~~ ~,1, S N v.g. DEG ~. J `-~ i-~-- - ~ ~[I ! ~ I Ir J ~ zdkc.s I -- ',o L~ 3~~ ~I s~ .. -- S .. _ ~ F-_ -- _. t _ _ ---y- >'t''~{~q CE~uNCF ~KZHT ANl~ E~"'Ss -rb +4bUIT1owPQ C~TI'FIGh-1aIN'~S_ w icL, '~ Qt'-Z~u~ IR£D - I it ,{ 'u r y h ti 3~ ~ -. ~ I i PLUMBER i/~{~TIFICATION l ,l ON LEAD COeITENT BEFORE r CERTIFICATE dF OCCUPANCY - SOLg~F~JUSED IN WATER SUPP ~'YSYSTEM CANNOT EdCCE~Diy~2/10 OF 1 % LEAD. ~ r Fx~,~TNb 3I o ~' 2. ~. ~: PLUMBING ALL PLUMBING WASTE & WATER LINES NEED, !STING BEFORE COVERI~JG ~- -_~ _ _ ~- So _3J OCC ' ANCY pR USE S UNLAWFUL WITHOUT CERTIFICATE OF;000UPANCY ~~/~5.4