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Home My WebLink About34685-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z 33787 I~mte: 06/18/09 THIS CERTIFIES that the building FINISH BASEMENT Location of Property: 415 RACHAELS RD NL~TTITUCK (HOUSE NO.) (STREET) (HAMLET) Cotulty Tax l~ap No. 473889 Section 108 Block 4 Lot 7.46 Subdivision Filed Map NO. Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 1, 2009 pursuant to which Building Permit No. 34685-Z dated NL~Y 14, 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 "AS BUILT" FINISHED BASEMENT IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GERARD POOLE of the aforesaid building. (OWNER) SUFFOLI~ COUN~f DEPAItT~T OF F~LhJLTH APPROVAL N/A EI~C'i~tICI%L CERTIFIC_ATH NO. 4029208 05/15/09 PL~ER~ CERTIFICATION DASD 06 / 15 / 09 SUNRISE PLUMBING & HEAT Rev. 1/81 Form No. 6 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or !~k and submitted to the Building Department with the following: A. ]For new bufldinoo or new use: 1.. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or . topographic features.. Final Approval from Health Dept. of~ator supply and s~'wetl~e-diapoaal (8-9 form). Approval of electrical installation l¥om Board ofFir~ .U. nderwfiter~. 4. Sworn atat .eanont fi-om plumber e~ifying that tho solder ~ in ay~m colltain.q'lesa than 2il0 of 1% lead. mdnstrial buildlng; mliltiple residences.and ,qlmllar building8 alld installattons, a certificate 5. Commeroial building, ......... ~'~ ' '' .... of Code Compliane~ from archit~t or On~n~r responaible for the building. 6. Subm[t planning Boar~l Approval of complote<l site plan requirements; B. For existing 'buildings (prior' to April 9, 1957) non-conforming .nsea, o~ buildings and "pre'existing' land nses: 1. Aeeurat¢ survey of property ~howing all property lines, stl~t~, building and.unnsual natural or topographic features. 2. A.properly completed'application and consent to ins'peet signed by the applicant. If a Certificate of Oeeupaney is de~ied, the Building Inspector shall state thc reasons therefor in writing to the applicant. C. Fees L Certificate:of Occupancy - New dwetling $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. Certificate of Occupancy on Pre-e[isting Building- $100.00 3. Copy of Certificate of Occupancy - $.25 Updated Certificate of Occupancy- $50.00 T~mpomry Certificate ofOcenpancy - Residential $15.00, Commercial $15.00 New .Construction: House No. , Street .Owner or Owners ofProperty: ~-~<~F'd ~)~)t~___ · . Suffolk County Tax Map No 1,000, Section I ~ ~ ' Subdivision Old or Pre-existing Building: (check one) Hamlet mee q q t, Date of Permit. (:~ I~ - COq Filed Map. 'Lot: Applicant: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Underwriters Approval: Finai Certificate: /l ;~I (ch~ nature 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 JERARD W. POOL HUBBARD ELECTRIC 178 HUBBARD AVE 415 RACHAELS RD RIVERHEAD, NY 11901, MATTITUCK, NY 11952 Located at 415 RACHAELS RD MATTITUCK, NY 11952 Application Number: 4029208 Certificate Number: 4029208 Section; Block: Lot; Building Permit:. BDC: ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: 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 Ne~/ York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith onthelSth Day of May,Z0Og. Name QTY Rate Ratine Circuits Type Alarm and emergency equipment Sensor 1 0 0 Carbon Monoxide Sensor 1 0 0 Smoke Appliances and Accessories Exhaust Fan I 0 F.HP Miscellaneous as built Wiring And Devices Dimmer 1 0 120 V Fixture 4 0 Incandescent Outlet 4 0 Fixture Outlet 10 0 Gen, Purpose Paddle Fan 1 0 Receptacle 1 0 GFCI ReceptacJe 6 0 Gen, Purpose Switch 5 0 Gen, Purpose seal Continued on Next Page I 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. 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 HUBBARD ELECTRIC 178 HUBBARD AVE RIVERH EAD, NY 11901, JERARD W. POOL 415 RACHAELS RD MATTITUCK, NY 11952 Located at Application Number: 4029208 Section: Block: Described as a Residential 415 RACHAELS RD MATFITUCK, NY 11952 Lot: Certificate Number: 4029208 Building Permit:* BDC: ns11 occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, 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 the15th Day of May, 2009. Name QTY Rathe Rating Circuits Type An as built visual inspection, of the delineated electrical installation, determined that an obvious hazard is not present and the installation is believed to be in conformance with the applicable reference standard tbr the estimated period of constmodon of the premises wiring system 2 of 2 seal This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 05/05/2009 17:31 16312082937 IMPRESS 0884 PAGE 02/0: Town Hall Annex . 54375 Main Road P.O. Box 1179 Southo)d. New York ! 1971-0959 BUILDING DEPARTIVI~NT TOWN OF I$OUTI~OLD Telephone (6321) 7657180 Fax {~3 !) 765-9502 CERTIFICATION. Building Permit NO. .~ L/~a '~ ~ (Please pr~) - ' ' (Ple~e~t) ' I certify that the solder used. in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~/~ (PP~hbers Signature) Notary?ublic, ,--~c4~//2--. County FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34685 Z Date MAY 14, 2009 Permission is hereby granted to: GERARD POOLE 415 P~ACHELS RD MATTITUCK,NY 11952 for : AS BUILT FINISHED BASEMENT AS APPLIED FOR. at premises located at County Tax Map No. 473889 Section 108 pursuant to application dated MAY Building Inspector to expire on NOVEMBER 415 R3kCHAELS RD MATTITUCK Block 0004 Lot No. 007.046 1, 2009 and approved by the 14, 2010. Fee $ 400.00 Authorized Signature ORIGINAL Rev. 5/8/02 SURVEY OF PROPERTY ~ '1~-~ A T MA TTITUC ~ ~'~ ,.., TOWN OF SOUTHOLD ', ' ~ ~ SUFFOLK COUNTY, NY. P~ ,v,~' ~o".~ ~ ~ ~ ~ 1000 - 108- 04 - P/OX2 ~ ,. . ~ ~-~ ~ , Sc;~. ~" = 40' ~ ~ ~ ~ Sept ~ ~~.- ~" ~ '~ ~ ~Rr~eo to, James Deerkoski Deer Path Mattituck, NY 11952 (631) 298-7116 May01,2009 re.: Finished Basement Poole Residence 415 Rachelles Road Mattituck, NY To Whom It may Concern, The finished basement height is at 7'-7" high, as measured. The construction meets NYS residential construction code. Sincerely'~"',~x,. ~ James Deerk~'~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INSULATION REMARKS: I~{..FI NAL ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION DATE INSPECTOR~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ] I/,,.,,NJ~LATION [ ] FRAMING / STRAPPING [~'"] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE INSPECTOR ~~ rn~L~'~SPECT~ON ~PORT [ DATE I COUNTS FOUNDATION (IST) b,~ ~ FOUNDATION (2ND) ~ ~g~ ROUGH F~G & ~ m PL~G ~ ~ ~S~ATION PER N.Y. ~' ~ STATE E~RGY CODE ~DITION~ CO~ENTS ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN H~LL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined ,20 \ Approved Disapproved a/c Expiration / \ ' ! ,20 MAY I ?OOg BLDG. DEPT. PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Heahh 4 sets of Building Plans Planning Board approval Survev Check Septic Fom~ N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Mail to: Building Inspector Phone:°{I ")- ~'q_(_., - ").~ ccc(~ b gat lq}& PPLICATION FOR BUILDING PERMIT Date ,~ ] / INSTRUCTIONS ~pletely filled in by typewriter or iu 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 belbre issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Pemait 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. Thereai'ter, a kew 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, aqd regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ ] Dt /~t~ ~/r)~ /] . i "/2' , /].J2.,'~..o~ ' [I ~ (Signature of applicdnt or name, if a corporation) (Mailing address of applicant) {. i C[ .~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 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. Location of land on which proposed work will be done: , ~.~.~ House Number Street CountyTaxMapNo.,000 Section io~ Block Subdivision Filed Map No. Hamlet Lot "~, Lot State existing use and occupancy of premises and intended use and occupancy of proposed constructi6r,: a. Existing useandoccupancy '~..C~-~'~-'h~. / ~{6t/V b. Intended use and occupancy ~(_{ect~t),~ / Olcby Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost Fec If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work (Description) (To 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 Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth. Height_ Number of Stories 8. Dimensions of entire new construction: Front Rear Height Number of Stories 9. Sizeoflot: Front 10. Date of Purchase Rear Depth I C~ tlc{ Name of Former Owner Depth Rear 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation. YES 13. Will lot be re-graded? YES 14. Names of Owner of premises Name of Architect Name of Contractor NO INO)4 Will excess fill be removed from premises; YES Address Phone No. Address Phone No Address Phone No. NO 15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES NO * 1F 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 tbundation 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) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, c;~:!iNi£ D. BU~OH l'10tary Public, State of New Yonk (S)He is the No. 01BU6185050 ; ~nimi!J¢0rl Expires April (Contractor, Agent. Corporate Officer, etc.) ............. ' ........ '-[ij'~'0J~, of said owner or owners, and is duly authorized to perform or have pertbnned the said xvork and to make and file this application; that all statements contained in this application are true to the best et' his knowledge and belicf; and~at the work ~,ill be pedbnned in the manner set Ib~h in the applicati°n filed d~erewith' h Sworn to beibre me thi~ _ / I~ dayof J]~%~ 200~ j NotaW Public ' ~ Signature of Applicant REScheck Software Version 4.2.1 Compliance Certificate Energy Code: 2007 New York Energy Conservation Construction Code Location: Suffolk County, New York Construction Typo: Detached 1 or 2 Family Heating Type: Non-Electric Glazing Area Percentage: 100% Heating Degree Days: 5750 Construction Site: Owner/Agent: Poole Residence 415 Rachelles Road Mattituck, NY Compliance: 4.2% Better Than Code Maximum UA: 119 Your UA: 114 Designer/Contractor: James Deerkoski, P.E. 298-7116 Basement Wall 1: Solid Concrete or Masonry Wall height: 8.0' Depth below grade: 7.0' insulation depth: 8.0' Window 1: Wood Frame:Double Pane Floor 1: Slab-On-Grade:Heated Insulation depth: 0.0' 664 13.0 0.0 39 7 0.500 4 68 0.0 71 The proposed building represented in this document is consistent with the building plans, specifications, and other calculations submitted with this permit application. The proposed systems have been designed to meet the 2007 New York Energy Conservation Construction Code requirements. When a Registered Design Professional has stamped and signed this page, they are attesting that to the best of his/her knowledge, belief, and professional judgment, such plans o~fl~tions are in compliance with this Code. Date | I ' Name - Title Signa~ ? c_ ~ _-/.~ TOWN OF SOUTHOLD PROPERTY RECORD CARD TYPE OF BLD. -- ' [ J "~ ~ ,h./.~~- .~- ~ ~ - ~ ~ ~ ~ r FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT TOTAL 108.-4-7.46 9/06 COLOR TRIM M. B~ .~ ~ ~' -?- ~ : S ') ~.- / Foundation C ~ 'r--l Bath / ~ Dinette Extension ~ ~ ~ ~ ~ ~ Basement ~SL,~ Floors Extension Ext. Walls ~¢~,. ~(~ Interior Finish Extension Fire Place ~ Heat Patio Woodstove BR. ~ /0/~= ~oo '~ 7~ Dormer Fin. B. Deck ~ ¢: ~ ~ ~" / ~ Attic Breezeway ~ ~ ~°~ ~'0 Rooms 1st Floor Garage ~5 ~ ~ -~ ~ ~ ~riveway Rooms 2nd Floor Pool M.B~~ Extension ~ Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM District Section Block Lot 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 (~) for each Question is Required for a Complete Application) Yes N._~o 1 Will this Project Retain Ail Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all mn-off created by site cleadng and/or construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? 2 This Item shall include all Proposed Grade Changes and Slopes Contrelling Surface WaterFIow! Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural 3 Existing Grade Involving more than 200 Cubic Yards of Matedai within any Parcel? Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of 4 Five Thousand (5,000) Square Feet of Ground Surface? Is there a Natural Water Course Running through th~,. Site? 5 Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? 6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet Of Vedical Rise to One Hundred (100') of Horizontal Distance? Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off 7 into and/or in the direction of a Town tight-of-way? Will this Project Require the Placement of Material, Removal of Vegetation and/er the ConstmcUon of 8 any item Within the Town Right-of-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) 9 Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? 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 Permit EXEMPTION: Does this project meet the minimum standards for c~assification as an Agdculturel Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requiredl Yes No CONNE D. BUNCH cour TYOF .. .. .......... ss Notary Public. Stata of New ,~..-,~N°. 01BU6185050 That ! ........................... ...................................................... brh~g duly sworn, dc'poses ~md says(~~r Name of individual signing ~m~,) ~~;,~;~ ~)d fi)at he/she is ~e N0~ Public ~te ~ N~ m ...................................................................................................... No, 01~U6185050 ~ner, Contraaor, Agent, Coworate ~r,, ,,emmiss(0natc'~ ~hali~ffih'SbWblWC0~Ex0ires April 14, 20~ ......................... Owner an~or represen~dve of ~e Owner of O~er's, ~d is duly au~orized m have pe~ormed ~e s~d work ~d to m~e ~d file ~s application; ~at ~] s~tcmcnks con~ed in d~is application ~e ~e · at ~e work will be performed in ~e m~aer set for& in &e application filed here~d~. Sworn to be[ore me ~is; FORM - 06/07 UN~ ~, ~F~tTER8 CERTIFICATE hGQUtRED lull ~ M I] H I ON LEAD CONTENT BEFORE : (~3~) 298-2250 CATE OF OCCUPANCY ' ' ' - SOLDER USED IN WA TER ~ ~C'~: , :: ~,,, ,,,, m mm ? F.R.S.R..m UTILITIES m 7C5-1802 8AM lO 4PM FOR THE ~ [ ! AT FURNA E ..... i ~' 'k' ~ X ~ ' I I ~-u ~~ ~ ~l ALL (L ,b tv. ~, SHALL MEET THE , ~ ~ I REGU.:'SMEh~TS OF THE CODES OF NEW I ~ " .I YORK Si'ATS. NOT RxSPO~SIB~E FOR ."c T ~ x RECREATION AREA , , ~-. HOU~k~ ~TOAPROVED I II "--"-'"--"'"'-" , , II DES,~N OR CONS[RUCTION ERRORS. SLOPE 1/4 PER FOOT PITCH TO DRA~ ~ ~ ' , ....... OF THE TOWN CODE. _ , --, PLUMBING SCHEMATIC NTS -III I ~ ~ mi .. ' ' FOUNDATION P~N ,, SHEET NO: S~LE: 1/4" = ~'-0' LONG ISLAND SOUND MAP OF LAND 5~:.WiourLB~g_q?._: ~.Y~ ¢ JOHN ,Al' 5OUTHOLD TOWN OF SOUTHOLD, N.Y. ia. Mo~u m¢'4't