HomeMy WebLinkAbout37735-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
5/13/2013
CERTIFICATE OF OCCUPANCY
No: 36234 Date: 5/13/2013
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property: 605 Saltaire Way, Mattituck,
SCTM #: 473889 See/Block/Lot: 100.-1-19
Subdivision: Filed Map No.
conforms substantially to the Application for Building Permit heretofore
1/2/2013 pursuant to which Building Permit No.
was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for
Lot No.
filed in this ofliced dated
37735 dated 1/8/2013
which this certificate is issued is:
KITCHEN ALTERATION 1N AN EXISTING SINGLE FAMILY DWELLING AS APPI,TED FOR
The certificate is issued to
Kalich, Richard & Motto. Mary
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
37735 03-13-2013
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATION8
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 37735
Date: 1/8/2013
Permission is hereby granted to:
Kalich, Richard & Motto, Mary
605 Saltaire Way
Mattituck, NY 11952
To:
Kitchen alteration in an existing single family dwelling as applied for.
At premises located at:
605 Saltaire Way~ Mattituck
SCTM lit 473889
Sec/Block/Lot # 100.-1-19
Pursuant to application dated
To expire on 7/1012014.
Fees:
1/2/2013 and approved by the Building Inspector.
SINGLE FAMILY DWELLING - ADDITION OR ALTERATION
CO - RESIDENTIAL
Total:
$200.00
$50.00
$250.00
Building Inspector
Focm 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 ofproperiy 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. 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 &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 applicalion and consent to h~spect 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 ou Pre-existing Building - $~00.00
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:
.Location of Property: _
Old or Pre-existing Building:
Date.
(check one)
House No.
Owner or Ownem of Property: _ j~.
Suffolk County Tax Map No 1000, Section
subdivision
Permit NO. -"~ ~ 7 _2~ ~.~--
Health Dept. Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Street
Fee Submitted:
Date of Permit.
Block ./
Filed Map.
~ - [...~ Applicant:
Underwriters Approval:
Final Certificate: /
(check one)
Hamlet
Lot
Lot:
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Telephone (631) 765-1802
Fax (631) 765-9502
roqer.richert(~,town.sout hold. ny.us
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued TO: Kalich
~,ddress: 605 SaltaireWay City: Mattituck St: NY Zip: 11952
3uilding Permit#: 37735 Section: 1 00 Block: 1 Lot: lg
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
~,ontractor: DBA: Duffy Electric License No: 44991-me
SITE DETAILS
Residectial ~
Commedcal
New
Addition
Service 1 ph E~]
Service 3 ph
Main Panel
Sub Panel
Transformer
Disconnect
Other Equipment:
Office Use Only
Outdoor I st Floor Pool
Renovation 2nd Floor Hot Tub
Survey Attic Garage
INVENTORY
Hot Water GFCI Recpt
NC Condenser Single Recpt
NC Blower Range Recpt
Appliances Dryer Recpt
Switches Twist Lock
Ceiling Fixtures ~ HID Fixtures
Wall Fixtures I I Smoke Dotectors
Recessed Fixtures ~ CO Dmecters
Fluorescent Fixture J~ Pumps
Emergency Fixtures J~ Time Clocks
Exit Fixtures ~ TVSS
Inspector Signature:
Date: March 13 2013
Elect rical_Ceftificate.xls
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I~I~ATION
[ ] FRAMING / STRAPPING [ 1/]' FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARK_S: __ ~~__~--_~___~__ ____
DATE ~~/~ INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. NorthFork. net
Examined I/~ .20~
Approved I/~ ,20~_~
Disapproved a/c
Expiration '7/! 0 ,20 [ c/
BUILDING PERMIT APPLICATION CHECKLIST
PERMIT NO. ~ ~7~' 5~
BI DG DEPT.
TOW~a 0F SOLrI~t0[D
Building Inspector
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
Mail to:~~~_
APPLICATION FOR BUILDING PERMIT
Date _, 20
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, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on promises, 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.
q/
(Signature of applicant or name, ifa corporation)
(Mailing address of applicant) /[9'-~
)/
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises N0)~/ ~/~3 fi ] S ['Q
(As on the tax roll or latest deed)
If a~l~an~s~c~, sig~ure of d~ authorized officer
~ame and title of co,orate officer)
Builders License No. ~]~- ~
Plumbers License No. ~'~ I~ - ~ ~
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 Section l~O Block I
Subdivision Filed Map No.
Lot
Lot
lq
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
Estimated Cost ~[ ~9o~F)(/)· r/}~) Fee
If dwelling, number of dwelling units
If garage, number of cars
Addition
Other Work
Alteration
(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
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
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 fi.om premises? YES NO__
14. Names ofOwnerofpremises~OY~ ~/IC~ Addressjl~,,~l~oneNo. ~/7' ~J~--] '~q
Name of Architect Address Phone No
Name of Contractor I_~& ~ 9,4.% ~(flJ~]TD~' Address~/~/P ,,~ Phone No. ~ ~/ ~ $'~ -/~ b/:5'e:9
15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES__ NO __
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. ls 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
· IF YES, PROVIDE A COPY.
NO
STATE OF NEW YORK)
SS:
COUNTY OF~
~J~_~ I~_ ~ ~ }f_~. ~_ ] 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 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
r /"- Notary Publice ,~Y ' LOR~A ~ROVffCH
N~a~ Pub~, S~ of N~ Y~
Q~I~ in ~k ~
C~ ~ 1~1~15
Signature of Applicant
JAN 2 § 2013
P.O. Box 1179
~o1~ ~ 1 l~l~
T,d~phoue (681) 765-1802
BUILDING DEPARTNI]~'VF
TOWN OF 8OUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
Address: 3__~L,i ~0 % ~g I~d ~T ~ (~.o ,v ~/"~ jig'g-L/
'Phone No.: ,,, ~'l'0 - "~o (2 - .~"'~ J
JOBSITE INFORMATION: (*Indicates required information)
*Address: GOE
*Cross Street: ~o~
*Phone No.:
1000 . Section: Block: Lot:.
Permit No.:
Tax-Map District:
*BRIEF DESCRIPTION O,F WORK (Please Print ,Clearly) ' L'-~;¥J~, ~ UP.V,,'
(Please Circle All That Apply)
*Is job ready for inspection:
*Do-you need a Temp Oe. rtilicate:
Temp Information (If-needed}
*Sen4~ Size: 1 Phase
~New Sen, ice: Re-eonneot
Addlt}enal Information:
(~NO.
Rough In Final
3Phase 100 150 200 300 350 400 Other
Underground Number of Meters Change of Service Overhead
PAYMENT DUE WITH APPLICATION
82-Reqt~st for Inspection Form
TOWN OF $OUTHOLD PROPERTY RECORD CARD
OWNER, STREET ~ (~,.~ VILLAGE DIST, SUB. LOT ,.~ ~
FORMER' OWN ER N E ACR. ' '
~; <__. S W ~PE O~BUILDING
~N D IMP. TOTAL DATE R~RKS
AGE BUILDING CONDITION
N~ NOR~L BELOW ABOVE
FA~ Acre Value Per Value
Acre
'illable FRONTAGE ON WATER
Vo~land FRONTAGE ON ROAD
Aeadow~d DEPTH
~ou~ Plot BULKH~D
~tal ~ ~ ~ ~ DOCK
TRIM
100.-1-19 7/12
r. xtensio_n ~
Extension
Extension
Porch~ /)~ ~
Porch
Breezeway
Garage
Patio
Total
Foundation
Ext. Walls
Fire Place
T?~I Roof
Recreation Room
Dor?Z
Bath
Floors
Interior Finish
Heat
Rooms 1St Floor
Rooms 2nd Floor
Driveway
DR.
BR.
FIN. B
New York State Insurance Fund
~Yorkers' Compensation & Disability Benefits Specialists Since 1914
8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129
Phone: (631) 7564300
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
^^^^^^ 542116284
LEX CONSTRUCTION & DEVELOPMENT
TA LEXUS CONSTRUCTION & DEVELOPMENT
91 LAKELAND AVENUE
PATCHOGUE NY 11772
POLICYHOLDER CERTIFICATE HOLDER
LEX CONSTRUCTION & DEVELOPMENT INC TOWN OF SOUTHHOLD
TA LEXUS CONSTRUCTION & DEVELOPMENT PO BOX 1179
917-14 & 917-15 LINCOLN AVENUE SOUTHOLD NY 11971
HOLBROOK NYl1741
POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE
I 1319 854-4 305548 04/18/2012 TO 04/18/2013 12/3/2012
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 1319 854~1 UNTIL 04/18/2013, 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, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/18/2013 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE,
10 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 NOTASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
RICHARD SCHANDEL (PRES) OF
LEX MILLWORK INC (ENTITY)
ONE PERSON CORP
THIS CERTIFICATE IS ISSUED AS A MA'UI'ER OF INFORMATION ONLYANDCONFERS 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/certlcertval.asp or by calling (888) 875-5790
VALIDATION NUMBER: 570177104
Suffolk County Executive's Office of Consumer Affairs
VETERAHS MEMORIAL HIGHWAY ~ HAUPPAUGE, NEW YORK -I 1788
DATE ISSUED:
4/5/02 No. 31237-H
SUFFOLK COUNTY
Home Improvement Contractor License
This is to certify that ............ _RICHARD M SCHANDEL ......
doing business as__ ....... LEXU_S__CON_S_T_R_U~TIQ_.N~& DEVELO_PM~__N_T__INC ...........
having furnished the requtremenrs set forth in accordance with and subject to the provisions of applicable laws
rutes and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a
HOME IMPROVEMENT CONTRACTOR. in the County of Suffolk.
Coun~ of
Clifford C61¢man
SUFFOLK COUNTY DEPAR'i'NIENT
OF CONSUMER AFFAIRS
HOME IMPROVEMENT
CONTRACTOR
RICHARD M SCHANDEL
31237-H 002
~'~ ~ 04/01/2014
Additional. Businesses
Director
LEXCO-2
CERTIFICATE OF LIABILITY INSURANCE
OP iD: MO
17J03/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATWE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cerBflGato holder Is an ADDITIONAL INSURED, the p~llcy(le$) moat be endomed. If SUBROGATION IS WAIVED, subject to
the terms end conditions of the pollsy, nsrteln policies may require an endomemenL A statement on this certificate does not confer rights Io the
ce~flcete holder in lieu of such endomemsnl(s).
The Whflmore Group, Lid.
370 Old Counb¥ Road SIe.2ES
Garden CKy, NY 11630
516-746-4141
5t6-746-787~
Lex Construction & Development
91 Lakeland Ave
Patchogue, NY 11772
~.sunss A:lnterstate Fire&Casualty InsCo
,muaE~ a :Merchants Mutual Insurance Co.
2O4
NNC#
q,=KliriCAT~ HOLDER CANCELL~.TION SOUTHOL
PO Box 1179
,Southold, NY 1197t
~) 1988-~10 ACORD CO~O~ON. All ~gh~ msewed.
ACORD 25 (20101~) ~e ACORD name and logo am mglste~d marks of ACORD
THIS IS TO ,~.=r;Y,: ~' THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATES. NOT~MTHSTANDING At~Y REQUIREMEHT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VETH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUES OR M/W PERTAIN. THE INSURAHCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND COHOITIONS OF SUCH POUCIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlS CLAIMS.
I ~'~ UWLm' ~ OCCUesENC~ Is 1,000,00O
A X~ COMMERCtALG ENERAL LIABffJTY X LHBtO02228 06/08/12 06/08/13 ~ TO RENTED
t~0,000
~ c~,~sw~ ~ occ~
, ~ED ~CP (~v one peres) $,000
B ~- ~u'~o CAPI053317 10/30/12 10/30/13 8OO~LYINJURy(Petp~sen)
~ ~ ~M'~.M~_.~ _, .wm~..OF. ~O~=J~, .TI?NS./L .O~110NS ,' VEHICLES (At'ch ACORD t0t
;erulicam tloloer m inclualm as an add Ifona nsured.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
isceF~ I::
100% CD's Dec. 24, 12 ~IC~_.
OCCUPANCY OR
USEIS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
po¢,¢~] Tm b]Al~LI
:lb-~ l Il'lB A~~lJ __
--f ~o
APPROVED AS NOTED
DATE: ~///~ B.p.#..~"~'~,/;")'-~
NOTIFY BUILDING [~ i:/',RTMENT AT
765-1802 8AM TO 4PM FOR THE
FOLLOWING INSPECTIONS;
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMiNS & PLUMBING
3. INSULATION
4. FINAL - COiT..-TRUCIION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALl. MEET THE
REQUIREMENTS OF THE COPES OF NEW
YORK STATE. NOT RESPOIJ$1BLE FOR
DESIGN OR CONSTRUCTICN ERRORS.