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Home My WebLink About34222-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34181 Date: 02/04/10 THIS CERTIFIES that the building INTERIOR ALTERATION Location of Property: 2190 LONG CREEK DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 55 Block 7 Lot 6 subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 9, 2008 pursuant to which Building Permit No. 34222-Z dated OCTOBER 10, 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" INTERIOR ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ALAN & KELLY ROSENBLOOM (OWNER) of the aforesaid building. SUFPOLKCOUNTYDEPARTMENT OF HEALTH APPRO~-AL BI.Rt-i-KICAL CERTIFICATE NO. pLDI~ERS CERTIFICATION DA'£~U3 Rev. 1/81 N/A 125647C 01/29/10 02/02/10 GEORGE FREDRICK Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF This application must be filled in by typewriter or ink and submitted to with the f A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval o f 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. 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 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. Ifa 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 - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Old or Pre-existing Building: ~" (check one) Location of eroperty: ~)/[(~0 a ~OStr'r~'l/P~J~--'- ~' ~f~{~'Hamlet Owner or Owners ofUropHe°rt;iN°' ~k fx_{^ ~'~ ~d]( 00'At' Suffolk County Tax Map No1000, Section 5~' Block 7 Lot (-,9 Subdivision Filed Map. Lot: Permit No..~L~ ?_,,'2~?_,,-' Date of Permit. Applicant: (,,iff Health Dept. Approval: '~ Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ~ (check one) Fee Submitted: $ e>Q~'~ ~ iSi~gnatu~re Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (63 l) 765-1802 Fax (631) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOLr} CERTIFICATION Date: Building Permit No. Owner: Plumber: (Please print) ~ /_ (Please print) Sworn to before me this dayof~0~, 20} I certify that the solder used in the water supply system contains less than 2/10 of 1% CONNIE O. BUNCH Notary Public, State of ~/ew ror~ No. 01BU6185050 Oualified in Suffolk Court Commission Fx~ires April 14 ~0 ] ~_ Notary Public~ ~ County Issue Date 1/2 9/2 010 Electrical Inspection Certificate Electrical Inspection Service, Inc. Application Number 375 Dunton Avenue 125647C East Patchogue, New York t1772 (631) 286.6642 Issued To: Alan Rosenbloom Street: 2190 Long Creek Drieve Village: Southold Zip: 11971 Section: Block: Lot: Town: Southold Contractor: Shore Power Elec. Cont. Inc. Lic. # 42536-ME Was examined and found to be in compliance with the National Electrical Code. Commercial [] NVDefects [~ Pool ~_ lstFIoor [] Indoor I Basement ~ HotTub Residential ~ Det. Garage ~ Attic [] 2nd Floor :~ Outdoor ~ Addition ~ Survey Switches Receptacles 5 3 Dishwasher Washer/Amps Furnace Oil Gas Meter Amps Phase UG/OH / Bldg. Permit: 34222 Other Equipment Fixtures GFI Heaters A/C Fans 14 1 2 Dryer/Amps Oven Range/Amps Microwaves Circulators Smoke Detector Bell Tre~sformer Jacuzzi Television CO Detector Hugo S. Surdi President Rough Inspection: 10/22/2008 __ I n sp~/~,~ ~~ ~ns~or: Jo~ Mc Mahon III This certificate must not be altered in any manner. Inspectors may be identified by their credentials. 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. 34222 Z Date OCTOBER 10, 2008 Permission is hereby granted to: ALAIq ROSENBLOOM 2 90 LONG CREEK DRIVE SOUTHOLD,NY 11971 for : "AS BUILT" MINOR INTERIOR ALTER3kTION AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 055 pursuant to application dated OCTOBER Building Inspector to expire on APRIL 2190 LONG CREEK DR SOUTHOLD Block 0007 Lot No. 006 9, 2008 and approved by the 10, 2010. Fee $ 400.00 Authorized Signature Rev. 5/8/02 ORIGINAL TOWN OF~~~q]ll~ DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING / STRAFPING FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION REMARKS. ~ [ ] ROUGH PLBG. [ ] INSULATION [ ~] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION DATE/~?/~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUG~LBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ~]/FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMA~ ~~~' _ DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTI ON [ ] FOUNDATION 1ST [~'I:IOUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [~}-F/RAMING/STRAPPING [ ] FINAL []FIREPLACE&CHIMNEY [ ] fiRE SAFETY INSPECTION [ ] fiRE RESlSTAKr CONSlIIUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: //~~ ~-~ EltC£D INSPECTION REPORT I DATE FOU-NI)ATION (1ST) FO1. _r'qDATION (2ND) ROUGH FP._~.flNG & pLI.~I~ENG INSULATION PER N. Y. STATE ENERGY CODE F~.~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TO'~N HALL'' SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.neffSouthold/ Examined ,20__ Approved ,20__ Disapproved a/c Expiration ,20 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 Contact: Mail to: ~-,~--~OT$:~:-~ Lt/R/-~-~tl Phone: ~.'~../. ~..~'~:~ , ~ .~2t~ ~ ~B~ uilding Inspector c~ ' ~PPLICATION FOR BUILDING PERMIT ~ ~3 Date ~- ~ 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,' ac-om'ate 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 at~er 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. (Signature of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises /~:~//zS/TZ~ (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 Hamlet County Tax Map No. 1000 Subdivision (Name) Section Block Lot Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~-~_~. ~5~O~> 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work Fee ~i~.-20t~ (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 D~pth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear .Depth 9. Size of lot: Front Rear .Depth 10. Date of Purchase OtYJ/~9/~ 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__ 13. Will lot be re-graded? YES__ NO __Will excess fill be removed from premises? YES__ NO__ 14. Names of Owner of premises/~. ~o~It, O/Ft~ Address ~ ~"~'/~'~/¢/~?Phone No. ~ Name of Architect Address Phone No Name of Contractor ~ ~4J~/fao Address l~~ltff.~Phone No. ~ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO It/ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE~QUIRED. 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) -/~-----~,7~_ ~/,r/~/gt~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (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 tree 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 (~'t'~ day of~ 20 tary Publ~ Signature of Applicant SU~¥~Y O~ LOT il LONG POND ESTATES SOOTHOLD ~0 4 ~/2 ~ 60 ~ [ ~?.[ ..... ~tH', ............ ~ ]xX~ I ~ ~ 3~ ~ -~ ,, .... ~~ ~, ~. ~ CDER~ITERSOERTIFIOATE Ft'E:~=.~=. "~AT L ' iVl~dl LI~ '¢~J~RED CC;,:CREEE II EH/R/ FRAMING & PLU~'.5~NG 4. FINAL LE;'= :"q (;.0% I', I YORI( ST~I E NOT F~;SSF'ON~ DESIGN OF ~ONS~RUC u ~NO'.',' :-; FLEISCHMANN ROSENBLOOM Oi':- OCGUPANCY