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HomeMy WebLinkAbout34498-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33626 Date: 03/31/09 THIS CERTIFIES that the building ALTERATION Location of Property: 710 SOUND AVE GREENPORT {HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 35 Block 1 Lot 12 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 27, 2009 purs,,~-t to which Building Pel~nit No. 34498-Z dated M3~RCH 11, 2009 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 BASEMENT ALTERATION AS APPLIED FOR. The certificate is issued to JACK & EDWINA SKREZEC (OWNER) of the aforesaid building. SI~F~)LK ~%~l"f DEPAR~T OF }~%J~TH APPRO~J~ N/A RT.R,jrKICAL CERTIFICATE NO. 09-1564 03/24/09 PLUMBERS U~KTIFICATION DA'£~ 03/17/09 JOSEPH TANTILLO Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPA This application must be filled in by typewriter or ink and submitted to the Building A. For new building or new use: 1. ~ar t mL'Irt~7ilIii]~K, fB~l~wing:/ TOWN OF SOlJTHOtO / 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 (8-9 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 1% lead. 5. Commemial building, industrial building, multiple residences and similar bui!dings 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 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 l. 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 Certificate of Occupancy - Resideatial $15.00, Commercial $15.00 Date. New Construction: Old or Pre-existing Building: Location of Property: ~-) C~ ~{~ ~ ~Iouse No. Streei Owner or Owners of Property: ~ + ~1~ Suffolk Co~ty T~ Map No 1000, S~fion ~ (check one~.~.~ Hamlet Block I Lot Subdivision Date of Permit. Filed Map. Applicant: Lot: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~:~ q M q ~ Final Certificate: (check one) Applicant Signature Electrical Inspectors, Inc. 308 East Meadow Avenue East Meadow, NY 11554 Office: (516) 794-0400 (631)396-7474 Fax: (516) 794-5854 Website: www.electricalin spectors.com Email: inlb~electricalin spectors.com Mail To: Nassau/Suffolk Electric Richard Yudess 401 Railroad Avenue Westbury, NY 11590 License#: 3955E CertificateNumber: 09-1564 Municipality: Southold, Town Of Inspector: 124 Issue Date: 3/24/2009 Property Address: Duchett 28 Sound Road Greenpofl, NY 11944 ELECTRICAL APPR 0 VAL CER TIFICA TE AREAS LISTED BELOW ARE APPROVED BY INSPECTION AND FOUND TO BE 1N COMPLIANCE WITH THE NATIONAL ELECTRIC CODE No visual detkcls were Ibund lbr the electrical inspection provided. No obvious unsatisfactory conditions were found in the areas herein below only. Residential Closed Wall Inspection Finished Basement: Bathroom, Bedroom, Playroom, Office, Outside Entrance 17- Duplex Receptacles, I- GFI Receptacle, 1- Smoke Detector, 9- Switches, 10- Recessed Fixtures, 2- Incandescent Fixtures. l- Wall Sconce. 1 - Exhaust Fan, 3- 4 Ft. Electric Baseboard Healers, 1- 220 V Thermostat. * I~.ichard M. Bivone President Not valid unless signed by an aut~.a~ized Ell Agent Philip F. Goehring Chief Electrical Inspector ~ ~ ~' CERTIFICATION Date: Building Permit No. Owner: (Please print) Plumber: (Please print) [ certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this day of [f/arc~ , 20 09 (Plumbers Signature) Nota- ,.RQBERT AMUNDSEN [Y I~"~!!c St~-~ ~'~ ~'~ vrC~ounty No. 01AM618~17 Q~I~ in Su~lk Coun~ ~y ~m~ion ~pir~ Janua~ 14, 2012 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEP~_RTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34498 Z Date MARCH 11, 2009 Permission is hereby granted to: JACK & EDWINA SKREZEC GREENPORT,NY 11944 for : INTERIOR BASEMENT ALTERATION AS APPLIED FOR at premises located at 710 SOUND AVE County Tax Map No. 473889 Section 035 Block pursuant to application dated FEBRUARY 27, 2009 Building Inspector to expire on SEPTEMBER 11, GREENPORT 0001 Lot No. 012 and approved by the 2010. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INS/JJLATION [~NAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE INSPECTOR Nassau S u fro l k Mechanical March 27, 2009 RE: Duchett 28 Som~d Road Greenport, NY 11944 To whom it may concern: Please be advised that all plumbing work in basement renovation has been done to all applicable codes. Y, President Nassau Suffolk Mechanical n to before me thisrfl/_ day of////t~t~ Q pi 20 0 ~ Notary Public, Suffolk County, N.Y., No. 401 RAILROAD AVE. · WESTBURY, NY 11590 PHONE: 1(888) 266-5758 FAX: (63 I) 475-5021 JAMES A. RICHTER R.A. ~ 705 FRONT STREET ~ GREENPORT, NY 11944 UUI 14AR 20 2009 March 19, 2009 / 8LDr~ DEPT. TOWN OF $OUTHOLD ROUTHOLD TnWN BUILDINB DEPT P. O. Box I l?g 5nUTHnLD TnWN HALL 5OUTHOLD~ NEW YORK 1197 I Re: Building Permit#:34498 Skmzec Residence 710 Sound Avenue Greenpo~, N.Y. 11944 I have completed a site inspection of the as-built construction for the above referenced project. I have also reviewed the National Evaluation Report (NER-635) for the Owens Coming Basement Wall Finishing System used on this project. It would appear from my visual site inspection of the completed project, that all work has been performed in accordance with the manufacturer's installation manual. Additional sprayed-on foam insulation has also been installed at the perimeter of the existing first floor along the box beam at the ends of the first floor joists to complete the thermal seal of the basement area. Based on my visual observations and the data found in the National Evaluation Report, the thermal envelope for the renovated basement area in this existing residence meets the minimum requirements listed in the Energy Conservation Construction Code of the State of New York. If you have any additional questions regarding this matter, please do not hesitate to contact my office. FIELD I/qSPECTION REPORT FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING -- INSULATION PER N. Y. STATE ENERGY CODE ~ / ~ .~' New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE LOVELL SAFETY MGMT CO., LLC 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER ALURE HOME IMPROVEMENTS INC ONE COMMERCIAL COURT PLAINVIEW NY 11803 ' CERTIFICATE HOLDER DOUCETT 28 SOUND ROAD GREENPORT NY 11944 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 1282 566-7 498947 04~01/2008 TO 04/01/2010 1/28/2009 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1282 566-7 UNTIL 04/01/2010, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANDCONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-26.3 NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif, com/ceCJcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 116794847 ACORD.. CERTIFICATE OF LIABILITY INSURANCE o.,o TH DATE MM,DD I ALURE-1 01/29/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Amerisc Corp (amerisc. cum) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Construction Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 777 Zeckendorf Blvd., Suite 2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Garden City NY 11530 Phone: 516-745-7500 Fax: 516-745-7565 INSURERS AFFORDING COVERAGE NAIC# INSURER B: Alure Home Improvements Inc Alure Basemen%s_ Inc. INSURERC: 1999 Hem~.stead Turnpike INSURERD: East Meadow NY 1155~ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT%MTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V~TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY RAVE SEEN REDUCED BY PAID C~AIMS. LTR INSRI TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/~f~ BATE IMMIDD/YY) LIMITE GENERAL LIABILITY EACH OCCURRENCE $ i r 000,000 A X ' COMMERCIAL GENERAL L~BILITY MPA3M3901 11/02/08 11/02/09 u~wuc,u.=.~cu $ 100,000 ] CLAIMS MADE [] OCCUR MEDEXP(Anyonepemon) $ 5t 000 PERSONAL & ADV INJURY $ lf000f000 GENERAL AGGREGATE $ 2,0001000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG s 2;000,000 I POLICY ~ JECT ~LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 ~ 000 t 000 A X ANYAUTO BA3M3901 11/02/08 11/02/09 (Eaac~de~) -- (Per acc~er~) EXCESSPJMBRELLA L~BILITY EACH OCCURRENCE $ 10; 000 ~ 000 A ~ occu~ [] C~IMSMADE ~E3M3901 11/02/08 11/02/09 AGGRE~TE S 10,000 ~ 000 S RETENTION $10f000 $ WORRERSDOMPER ONAND ITORY.MITB t' CERTIFICATE HOLDER CANCELLATION DOUCETT Douoett 28 Sound Road Greenport, NY 11944 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP~RATIO I~ ViC]THE AMERISC CDRP ACORD 25 (2001108) .... © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) OWNER TOWN OF SOUTHOLD PROPERTY RECORD CARD VILLAGE SUB. LOT DWN RES. FARM COMM. CB. MISC. ACR./ 250- TYPE OF BUILDING Mkt. Value LAND IMP. TOTAL DATE d~ REMARKS AGE .F Tillable 1 Tillable 2 TYi'iable 3 Woodland Swampland Brushlond House PLot TotaJl~ ~.~ NORMAL Acre o~ BUILDING BELOW Value Per Acre ABOVE Value FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD DOCK M. Bldg. Extension Extension Extension Porch Garage Patio Total TRIM ~*~cla t i o n C~ Bath 3asement ~.(~ - Floors Ext. Walls Interior Finish Fire Place' Type Roof Heat Rooms 1st Floor Recreation Room Rooms 2nd Floor YOU Dormer ~Drlveway M. Bldg. TRIM J Dine :PLUMBING ALL PLUMBING WASTE &WATER UNE$ NEED _ TESTING BEFORE CO~ PLUMBER CER.TIFICA T/ON ON LEAD CONTENT BEFO~, £ CERTIFICATE OF OCCUPANc.'y' SOLDER ~.~.~ w,~ 7~ ~ SUPPLY SYSTEM CAN&,'~ T --- (~ 4 ELEC BASEBOARD Exterior Stairs By Long Island Not By Alum Egress BEDROOM FAMILY ROOM UNDERV~ITER~ CERTiFiCA~ AL~L C~''' ~: HALL REQUIRED . .~E~T_,. ; ~*~ OF THE u~;: ~ .... ~ ~,_:., .... :~ STATE. 'i 8oilerRVH 1/2' Pump 3pc Bath Create w pump FF;'. %.Eg~s_ --~.__.~ FOLLO.V',N5 I. FOU~;p .... FOR ,. .... D ROu,.~r: ' rRAMi,~G OFFICEr. i~: L:~ ( - : ALL C, · -: C'F NEW ~ ;LE FOR ERRORS. Doucett Groenport 2.5" DC perimeter 1" DC inter[or Slider 4' ELEC BASEBOARDI~ ~Closet 4' ELEC ~ Shelf& Pole BASEBOARD 22'-5 1/2' 31'-11 1/2" TOWN OF S6UIPHOLD BUILOII~G.DE PA.I~TMENT TOWN HALL · SOUTHOLD~ NY 11971 TEL: (631) 765-180:l FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined .~/// Approved 3/// , 2(~ Disapproved a/ Expiration q/[[ ,20/0 ,, BLDG. DE~. TOWN OF SOUTHOLO PERMIT NO. 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 Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: Building Inspector [,ICATION FOR BUILDING PERMIT INSTRUCTIONS Date 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 Southold, 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. ~ ~Signamre of ap~ii'~h~ dr nt~me, ifa corporation) ~Mailing address'of appli~'ant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder If applicant is a corporation, sigxtature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: l-J~)/se Number Street County Tax Map No. 1000 Section 5~- Subdivision Block Filed MapNo. Hamlet I Lot /&, Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed const~ction~ a. Existing use and occupancy ,~~~ ~ b. Intended use and occupancy y o 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost '~//~,~. od Fee ,~, Addition Other Work Alteration (Description) (To be paid on filing this application) If dwelling, number of dwelling units -~ ~ Number of dwelling units on each floor ,~rt~ If garage, number of cars ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front /~//~ ' Rear /j ~ Depth Height_ Number of Stories Dimensions of same structure with alterations or additions: Front : Rear Depth Height. Number,of,, Stories, , ~,~ ~ ~, ,..,~,'' 8. Dimensions of entire new construction: Front Rear I i Depth Height Numberof Stories ~,~ ' 9. Size of lot: Front ~,.,~ Rear .~i~7' 7,J'r Depth /~/,,~ 10. Date of Purchase r~ '~ 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__ 13. Will lot be re-graded? YES NO ~ 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 Address 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 ) A~.c.'~at_ ~'~ Z,c~ being duly swom, deposes and says that (s)he is the applicant .~"fi~ of individua~ signifCg contract) above named, isthe (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. Sworn to before me this ~ ff ~ta~ Pubhc/ N01A[Y PUStlC, State of New / / ~ No. 4804615, Suffolk Cou~y ~ Term Expires September Signature of Applicant