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Home My WebLink About35861-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34597 Date: 10/06/10 THIS CERTIFIES that the building ALTERATION Location of Property: 4710 OLD NORTH RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 55 Block 2 Lot 8.4 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26, 2010 pursuant to which Building ~erm/t No. 35861-Z dated SEPTEMBER 14, 2010 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" ALTERATION TO FINISH SECOND FLOOR IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOSEPH & NANCY MANDUCA ( OWNER ) of the aforesaid building. S~F05KC0[~l~fDEP~/{T~T OF H~ALTHAPPRO~i~L N/A EI~CT~ICAL C~KTIFICA~]~ NO. 35861 09/24/10 FLD)~ERS c~KTIFICATION DA'r~ 09/21/10 BURT'S RELIABLE Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEP2~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. 35861 Z Date SEPTEMBER 14, 2010 Permission is hereby granted to: J & N MANDUCA 4710 OLD NORTH RD SOUTHOLD,NY 11971 for : "AS BUILT" ALTERATION OF 2ND FLOOR TO LIVING SPACE AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 055 pursuant to application dated AUGUST Building Inspector to expire on MARCH 4710 OLD NORTH RD SOUTHOLD Block 0002 I~t No. 008.004 26, 2010 and approved by the 14, 2012. Fee $ 400.00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: 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. 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 buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Plarming Board Approval of completed site plan requirements. 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 I. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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 Date. New Construction: Old or Pre-existing Building: (check one) LocationofProperty: L~'~[O O~d~k_ ~x'~(~)('A~ ~ SC3,..x.~--~'-(t House No. Street Hamlet OwnerorOwnersoferoperty: '~CD~2,-'rr--~/h ~C ~x~Ct.o,i"NGa,~ ~/N~LLk C_Lq Suffolk County Tax Map No 1000, Section /-~' Block ~'~ Lot Subdivision Permit No. ~6~ Health Dept. Approval: Planning Board Approval: Date of Permit. Filed Map. Applicant: Underwriters Approval: Lot: Request fbr: Temporary Certificate Fee Submitted: $ Final Certificate: (check one) Applicant Signature Tov~ii H;dl Anne× .5 t37,5 Mam Road P.(). Box 117!) ~oul]lold, NY 1 [ 9714~9.59 Tclcphonc Fax {63 I ro.qer, richert~,town southo d ny us 1½1 :ILl)IN(; DI.;I'ARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: J Manduca ~ddress: 4710 Old North Rd City: Southold St: NY Zip: 11971 ~uilding Permit#: 35861 Section: 55 Block: 2 Lot: 8.z WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: License No: SITE DETAILS Office Use Only Residential R Ind°°r ~ Basement ~ Service Only ~ Commedcal Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ CeilingFixtures ~ HIDFixtures ~~ Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel NC Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel NC Blower Range Recpt Fluorescent Fixture L~ Pumps Transformer Appliances Dryer Recpt Emergency Fixture~ Time Clocks Disconnect Switches Twist Lock Exit Fixtures ~ TVSS Other Equipment: finnish second floor Notes: Inspector Signature: Date: Sept 24 2010 81-Ced Electrical Compliance Form T(m]~ 1 tall Annex 51,'17,5 Main Road P.O. Box 1179 Southold. NY 115171-0959 Tclcpl~onc (631) 763-1802 l:ax (631) 76,3-9,502 m.qer, richert~town.southold, ny. us BI TIIJ)IN(; I)EPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: J Manduca ~,ddress: 4710 Old North Rd City: Southold St: NY Zip: 11971 3uilding Permit #: 35861 Section: 55 Block: 2 Lot: 8.z WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: License No: SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 3 ph Hot Water GFCl Recpt Wall Fixtures I 21 Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures I 41 CO Detectors Sub Panel NC Blower Range Recpt Fluorescent Fixture[ I Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches Twist Lock Exit Fixtures ~ TVSS Other Equipment: finnish second floor Notes: Inspector Signature: Date: Sept 24 2010 81-Cert Electrical Compliance Form Town Hall Annex 54375 Main Road P.O. Box 1179 Sou~hold, New York 11971-0959 Telephone (631 ) 765-1802 Fax (63 I) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTIIOLn CERTIFICATION Building Permit No. __'~c~'' ~ ~ / Owner:dCg~C~/%L '7L/7'/~ ~ 7 (PI~e prMt) (PIe~e prht) I certify that the solder used in the water supply system contains less tl~ lead. Sworn to before me this ~ / St dayof .c-) ~oD~C~ De.r-, Notary Public, ,_~, ] ~-f~lt~ County a 2/10 of 1% (Plumbers Signature) SEP 2 7 010 BLDG tlEPT. TOWN OP SOUTNOLO BERNADETTE L. TAPLIN NOTARY PUBLIC ~1844893 State of New York Residing in SaflOk County No,' DT, dot3 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING / STRAPPING [ ] ROUGH PLBG. [ ] INS~IL-A~ION I~]'~INAL [ ] FIREPLACE & CHIMNEY [ ] fiRE SAFETY INSPECTION [ ] FIlIERESISTi~I'CONSTRUCTII~ [ ] FIRE RESISTANT FF. NETRATION REMARKS: ~-/~,/~(~ ~-~-~---/~ Date: To: Re: JAMES J. DEERKOSKI P.E. 260Deer Drive Mattituck, NY 11952 (631) 774 7355 September 20, 2010 Town of Southold Building Dept Certification Manduca 4710 Old North Rd. Southold, NY 11971 Permit# 35861 To Whom It May Concern: This is to certify that all work completed under Building Permit #35861 was done as per Iclfa~'ouanhtvmee~tnSyalqlu;ts;ti;nasn,dpll;a~°di~;~;hsi; tait~nteo;fo~l~cSttr~Ceti°~ilank-- You. \ Sincerely, Ja~ J Deerkoski SEP 2 7 BLDG. DEPI. IOV~N OF SOUIHOII) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined Approved Disapproved a/c Expiration '~/] q ,20J'~,_~ AUG 2 6 2010 BLDG. DEPT. TOWN OF SOUTHOLD PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health .~'~sets of Building Plans Planning Board approval Check Septic Form Flood Permit Contact: Mail to: Phone: 7~-~ / Building Inspector ,ICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,20/ ely 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. (__/// (~fgn~'(~/e of applicant or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~-'~q~__/D~ ~ ~,ff/-]'b' ~-'/ (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. I. Location of land on which proposed work will be do~e: House Number Street Hamlet '~County Tax Map No. 1000 SeqtionLT/73<~'~-9 Subdivision ,~C~, '7/' Block Filed Map No. Lot Lot 2. State existing use and occupancy of premises and intended use and occupanc~ of prgposed construction: a. Existing use and occupancy ?,~ ~:-.5 / Z~5 ~/t-~d ~ C'Intended use and occupancy . .~¢~/~)~)/L-7"- ~,~/~c~_...z~,~ Addition Other Work 3. Nature of work (check which applicable): New Building Repair Removal Demolition Alteration (Description) Fee (To be paid on filing this application) 'Number of dwelling units on each floor 4. Estimated Cost If dwelling, number of dwelling units 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 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 ' .Depth Height Number of Stories 9. Size of lot: 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 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO__ 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * 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. NO 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at I 0 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) COUNTY O1~1 ~ 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 befbre me this .~,,~m dayof ~dYM~ 20./ID Notaw Public '~~Signature of Ap;licant TOWn of Southold ; Erosion, Sedimentation & S,torm'Water Run-off ASSESSMENT FORM THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM*WATER, GRADING, DRAINAGE AND EROSION CONTROL, pL~ma vlsi~ict section BtocK Lo~ ' CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATB OF N~N YO~ $COPE OF WOA~ - P~,O?OSED CONSTRUCI~ON ~# / WOI~E~i~iT a. What iS the Tofal Ama of the Pmjuct Parcels? (include Total Area of all Pan:els located within '~ VVllI this Project Retain NI Sterm-Wat~' Run-Off the Scope of Wor~ for Proix~ed Cons~u~m) ~eneretad by a Two (2") Inch R~tnfa, m S~? b. Whatlsthe TotalAmaofLandClesring (e.F./~) ('~lsltem~llindudeallruc-offcmatadbyslte clearfog and/or construction activities as wa~ as all and/or Ground Disturbance for the pmpesed Site Impmvemente a~J the permanent orea~en of constu~:~ activity? impervious suffasas.) (s,.,,=,,) 2Does the S}te Plan and/or Survey Show All Proposed Item shall include all ~ Grade Changes and Slopes Centmlling Surfaco Water Plow. 3 D°es the Site Plen and/or Survey describe the eresinn ~/" [-~-.-~ and sediment conbol Pmcllass that will be used to control ate erosion and stetro water discharges. This item must be meintethed throughout the En~m Constmc~inn Period. 4 Will this Project Reduim any Land Riling, Grading or Excavation where there is a dnenge to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcei? 5 Will this ApplicaUon Require Land Disturbing Ac~vitiee Encompassing an Area in Excess of Five 'l~oussnd (5.000 S,F.) Square Feet of Ground Surface?~ -- 6 ~s there a Natural Water Coume Running through the Site? Is this ProjeCt within the Tmsteee jurisdiction r~ General DEC ~WPPp Requfn~nettto: or within One Hundred (100') feet of a Wetiand Or~ -- Submission o/a SWPPP I~ required io~ all Cons~ucti~n actlvi~es invoh,ing SOil Beech? dlstorba~"esofone(1)orrn~eacms;includingdistorbancesoflessthano~eacmthat 7 W~i'therebeSitepreparationonExlsUngGradesiopesr----.~ are part °f e lan3er c°mrn°n Pran that w~l ullimately disturb °ne °r m°re acme of ~; wbich Exceed Fifteen (15) feet of Ve~cel Rise to Ir tctoding C~lstoJcflon activities i~ving soil disturbances of isss t~ar~ o~e (1) acm where One Hundred (100') of Horizontal Disteqce? L~J the DEC has detormlm~d that a SPDES permit is required for stomt wate~ discharges. -- SWPI~P's Shall meet the Minimum Requirements o! the SPOES General Permit 8 Will Drf~eways, Parking Areas or other Impervious tot Storm Wa~r D~scharges from C~struofton a~6v~ty - Permit No. $P-0-10-001.) Surfaces be Sloped to Direct Storr~Water Rull-Off t. Tba SWPPP she# be preba~d prior to the su~mmtsl of the NOI. The NCt shall be into and/or in the direction of a Town ~ght"Of-way?~ -- submitted to the Depar~mmt prior to the commencement of constmcthm ac~Vdy. 2. The SWPPP ~all describe the ~ andsndlme~ cent~ prances and where 9 Will this Project Require the P~cemont of Material, required, Ix~t.co*~m~c~on st~xm wofer nmnaeemeof pra,~ces emt will be used and/0~ Removal of Vegetetipn andlor the Constaj~en of any cor, sm~ed to redm~ the poluton= In stem wof~ discbar9~ and to as~re Item Within the Town Right-of-Way or R°ad Shoulder __ STATEOFNEVv'YORK, ~', fr". C t~ CONNIEDmBUNCH COUNTY OF ...~....~..~:,...: ......... Notary Public,State of New York No. 01BU6185050 ... ~ Qualified in Suffolk Counb, {,:~- That I ................ ~._......_~.;z =.~. ~...=.;G ~.~;;,;;A;~ ................... berg duly swom, deposes and~/~~ ~b(ilaf~lli/~t for Perm/t, (j/ (/ (Owner, Cmbac~. A~mt. Comon~ Ollker, eto ) ........................................................... Owner and/or representative o~'~e Owner or Owners, and is duly anthofized to perform or have performed the said work and to make and file this application; that aJ] statements conta/ncd/n ti'ds appi/cadon are true to the best ofh/s knowledge and beJ/ef; and. that the work will be performed in the manner set forth/n the application filed berew/th. Sworn to before me th/s; .......... g;;o~;i; ........................... FORM - 06110 Town Hall ~mnex 54375 ~ Ro~ P.O. Box 1179 Somhold, NY 11971-0959 Telephone (63t) 765-1802 ro~er, rlcheriC~o (~.~o~u~o~.n¥.u~ BUr[.r~I~G DEPARTM TOWN OF $OUTHOLB APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: Address: Phone No.: *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: JOBSITE INFORMATION: (*Indicates. required information) 1000 Section: ~ Bbck: *BRIEF DESCRIPTION OF WORK (Please Print clearly) (Please Circle All: That Apply) *Is. job ready for inspection: ~/NO Rough In .*Do you need a Temp Certificate: ~YES / NO Final Temp-lnformation (If needed}. *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 *New Service: Re-connect Underground Number of Meters Change of Service Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form Other Overhead ,/600 - OWNER LAND TOWN OF SOUTHOLD PROPERTY--RECORD CARD ~P~L ~-~ Co,o, . JMP. TOTAL STREET /~ //,'j FARM DATE VILLAGE E 'otal ¥oodland FRONTAGE ON ROAD Aeaarowland DEPTH -louse Plot BULKHEAD FRONTAGE OKI WATER COM¢~. CB. MICS. Mkt Value · -- ~=x~er~sion Extension Extension Porch B re e zeway Potio 'rotel Foundation Basement /_/~ / Ext, Wafts lFire Place I Recreation Room Bath Floors [nten'or Finish Reot Rooms 1st Floor Rpoms 2nd Floor Driveway Dinette JFIN. B J UNDERWR1TE,~c ~. 12'-8" BATH n 12'-8" BEDROOM BEDROOM 15'-8" 11" 15'-8" BUILDIN~ I:)~P~ 8 AM TO 4 PM t-Or; INSPECTIONS: 1. - TWO REQUIRED ) CONCRETE 2 ~ - FRAMING, PLUMBING, RAPPING, ELECTRICAL & CAULKING 3 ~ ;AL - CONSTRUCTION & ELECTRICAL JST BE COMPLETE FOR C.O. MEET THE : THE CODES OF NEW , STATE. NOT RESPONSIBLE FOR ~c-.~ OR CONSTRUCTION ERRORS. 44'-0" ,~,LTEt~ATION$ 4110 OLD NO~TN F~[::'., ~,OUTNOL~ JD