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HomeMy WebLinkAbout37902-ZTown of Southoid Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY 5/2/2013 No: 36222 Date: 5/2/2013 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: ALTERATION 260 Peck PI, Southold, Sec/Block/Lot: 70.-3-11 Filed Map No. conforms substantially to the Application for Building Permit heretofore 4/1/2013 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 which this certificate is issued is: "as built" alteration to kitchen and bathroom and electrical service. Lot No. filed in this officed dated 37902 dated 4/1/2013 The certificate is issued to Lekich, Elsi (O'~NER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 4/29/I3 37902 5/1/13 thBurts Reliable Inc 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 SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 37902 Permission is hereby granted to: Lekich, Elsi Date: 4/1/2013 260 Peck PI Southold, NY 11971 To: AMENDED: Alteration to kitchen and bathroom and electrical service. At premises located at: 260 Peck PI, Southold SCTM # 473889 Sec/Block/Lot # 70.-3-11 Pursuant to application dated To expire on 10/1/2014. Fees: 4/112013 and approved by the Building Inspector. ELECTRIC AS BUILT - SINGLE FAMILY ADDITION/ALTERATION CO - ADDITION TO DWELLING $90.00 $611.20 $50.00 $751.20 Form ~o. 6 TOWN OF SOUTHOUD 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 &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 &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 Planning Board Approval of completed site plan requirements. 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly comp}eted 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 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 Pm-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 $15.00 New Construction: Location of Property: House No. Owner or Owners of Property: Suffolk County Tax Map No I000, Section Subdivision Permit No. '3 -~_~ff) ~ Date of Permit. Health Dept. Approval: Planning Board Approval: Old or Pre-existing Building: Street (check one) Request for: Temporary Certificate Fee Submitted:$ ...(-t/ ~t.] Hamlet (check one) Block ~ Lot Filed Map. Lot: f%~ q ~ Applicant: Underwriters Approval: 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 ro(~er.richert~town.southold.ny.us CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: Clancy ~,ddress: 260 Peck Place City: Southold St: NY Zip: 11971 ~uilding Permit #: 37902 Section: 70 Block: 3 LOt: 11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE ~ontractor: DBA: G&S Electric License No: 578-e SITE DETAILS Office Use Only Residential ~ Indcor ~ Basement Service Only ~ Cernmedcal Outdoor 1 st Floor Poel New Renovation 2nd Floor Hat Tub Addition Survey Attic Garage Service I ph SeiMce 3 ph Main Panel Sub Panel Transf(~-mer Disconnect Other Equipment: Hot Water NC Condenser NC Blower Appliances Switches 2-exhaust fans INVENTORY Duplec Recpt ~ GFCI Recpt Single Recpt Range Recpt Dryer Recpt Twist Lock Ceiling Fixtures E Wall Fixtures ~.~ Recessed Fixtures ~ ::;%;':u::L Exit Fixtures L HID Fixtures Smoke Datectors CO Detectors Pumps Time Clocks TVSS Inspector Signature: Date: Ma)/1 2013 Electdcal_Certificate.xls Towa Hall An~x 54375 Mai__n Road P.O. Box 1179 Southold, ~ York 11971-0959 B~.m .F~]NG DIiPARTMlilqT TOWN OF ~O -tl'l~Otr~ T'elephone (63-1).765~ 1802 Fax ('631 ) 76.q-9502 CERTIFICATION Building Pm'mAt No. owner: Plumber: (p~ print) t)CLs eA; e_ (PI~ prMt) I certify that the solder used in the water supply system containa leas than 2/10 o'f 1% le. ad. Sworn to before me this o~ (5} ,k dayof ~0£,'t , 20l:~ Notary Public, ~O 44DI ~_ County TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING/STRAPPiNG [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTiON [ ] FIRE RESISTANT CONSTRUCTION[ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [~LECTRICAL (FINAL) REMARKS: DATE- ~//3 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING/STRAPPING [ ] FIREPLACE & CHIMNEY INSPECTION [ ] ROUG.~.BG. [ ] IN.>~b'LATION [//]~INAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (RO~~/[ ,] ELECTRICAL (FINAL) REMARKS: q../~ ~ INSPECTOR Microsoft Word - building permit 2007.rtl- 39 TOINN OF SOUTHOLD BUILDIlNG DEPARTMENI TO~ I~LL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTowa._NorthForkmet http://ny- southold.civicpl us.com/DocumentCenter/Home/View/3 9 BUILDING PERMIt APPLICATION CHECKLIST Do you have or need the followins, b~for~ applyins? Board of Health 4 sets of Buildin8 Plans Planning Board approval Survey Check S~tic Form N.Y.$.D.E.C. ! / -- ~ Flood Pemait_ Examined ,/~/ / · .~'20~,''~] . 3,4Ue t~ pC: , Storm-Water Assessment Form. ,.- ~..--- ,,,-- ~ ///( co_: ~--- / ~STRUCTIONS . _~;,. ,?,:: ~22~_. ~ ........ Marl ~o: Phone: ~ ..~'~ BLDG DEP/ TOWN OF SOUTHO[O sets of plans, accurate plot plan to scale. Fec according to schedule. b. Plot plan showing location of lot and of buildings on pmnis~s, relationship to adjoining premis~ or public streets or areas, and waterways. c. 71~e work cov~d by this application may not be commeccod before issuance of Building Permit. d. Upon approval of this application, the Building lnspoctor will isst~ a Building P~nnit to the applicmt. Such a permit shall be kept on the },~,Ases available for inspection throughout the work. e. No building shall be occupied or used in whole or in pm't for any purpose what so ever until the Building Inspector issoes a Certificate of Occupancy. f. Every building pe~nit shall expire tithe work authorized has not comm~ac~d within 12 months after the date of issuance or has not been compl~'d within 18 months from such date. If no zoning amondm~nts or other mguiatiuns affecting the property have been onacted in the intexim, the Building Inspector may authorize, in vaiting, the extension of the permit for an addition six months. Thereafter, anew permit shall be requited. APPLICATION IS HEREBY MADE to the Building Dep,a tmunt for the issuance of a Building Permit pmsumt to the Building Zone Ordinmce of the Town of $otahold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildiugs, additions, or alterations or for r~moval ordemolition as herein d.esoribed~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing cycle, md authorized inspecto~ on premises and in buildiug for necessary inSl:nxtions. (Signatu~ of applicaat or n~ae, ifa corporation) {Mailin8 ~dth~ss of applicant) State whethor applicant is owner, lessee, agent, architect, ,ngin~r, gunerai contractor, electrician, plumber or builder .. ~. , / / i~_ t'' .... ' .~ I (As on thc tax roll or latc~t deed) (Name and title of eorporate~e'r) Builders License No. Plumbers Liccusc No. Electricians License No. Other Tmde's License No. Location of land on w'l~'eh, armposcd Work will 10c done: House Number Street County Tax Map No. 1000 Section [l(~ Block Subdivision Hamlet Filed Map No. Lot l/ 1 of 2 3/27/2013 3:37 PM Microsott Word - building permit 2007.rtf- 39 http://ny-southold.civicplus.com/DocumentCenter/Home/View/39 2. State existing use and occupaney of pre-~lises ~md intendedi use and pccup~'~.~ of pro~sed construction: b. Intondeduseandoecupancy %,r~('}l~_ x'~O ~ , l ~ G l de lq e ~:~ 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work estimated Cost ~.9~-'-~ ~ Fee If dwelling, number of dwelling units If garage, number of cars (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 ofe~isting structures, if any: Front Rear Depth Height. Number of Stories Dimensions of same structure with alterations or additions: Front Depth. Height Rear Number°fSt°fiea-i,;'~ ~ ~ ~,~,. Rear .Depth 8. Dimensions of e~tire new construction: Front Height Number of Stories 9. Size oflot: Front 1'~'~' Rear I 7~-'-' .Depth 10. Date of Purchase ~'~ [C~.~. Name ofF 11. Zone or use district in which premises arc situated ?.C%,~.e~a~ ~- I ~ 12. Does proposed eonsUuction 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 p, remises dt ~ r3~_~ ~©~"~ NamcofArchitect ~5)G..r~a,-r )"Dot~t~ Addrcss~o~-Plo ~ PhoneNo&'~t-Wo~C~(¢v7 Name ofContracto~ 't~t~l~ u fY~C~- AddressH ¢6-,,~O ~/ff-~ Phone No. . 15 a. Is this property w~thin 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRm. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PE~S MAY BE REQUIRED. 16. Provide survey, ~o scale, with accuratc foundation plaa 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. any covenants and restrictions with respect to this properbq * YES__ NO ~, 1 8. Are there · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) (Name of individual signing contract) above named, (S)He is the '\ ' (~ (Conlractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed thc said work and to make and file this application; that all statements contained in this application ~e tree to the best of his knowledge md belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ day of ffV\OA 0.~ 20 Iff) Notary PubliCRu~h Notary Public State of New York No. 0! L06054063 in Suffotk County [~'~j Qualified Commission Expires Mar¢~ 5, 20 ~ 2 of 2 Sign tare of Applicant 3/27/2013 3:37 PM Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 ro.qer, ncnert(~,town.soumolo ri%us BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: Address: ~hone No.: Date: ~ /'~ JOBSITE INFORMATION: (*indicates required information) *Name: *Cross Street: *Phone No.: ~'&-~"" .-'-'-'-'-'-'-'-'-~,~::::'/-~"" Pein'fit No.: ¢'77d- Tax Map District: 1000 Section: Block: .~ Lot: *BRIEF DESCRIPTION OF WORK (Please Pdnt Cleady) (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: YES (~ Temp Information (If needed] *Service Size: 1 phase *New Service: Re-connect Additional Information: 3Phase 100 150 200 300 350 400 Other Underground Number of Meters Change of Service Overh~ id PAYMENT DUE WITH APPLICATI(~N~ ~.%! / 82-Request for Inspection Form New York State Insurance Fund FFo rkers ' Compensation & Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 113125165 MCCARTHY MANAGEMENT INC 46520 ROUTE 48 SOUTHOLD NY 11971 POLICYHOLDER MCCARTHY MANAGEMENTINC 46520ROUTE48 SOUTHOLD NYl1971 CERTIFICATE HOLDER TOWN OF SOUTHOLD, BLDING DEPT. P.O. BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE I 1143 348-9 511101 03/30/2013 TO 03130/2014 4/15/2013 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1143 348-9 UNTIL 03/30/2014, 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 03/30/2014 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 NOT ASSUME 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. THOMAS J MCCARTHY THIS CERTIFICATE IS ISSUED AS A MA3q-ER OF INFORMATIONONLYANDCONFERS 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/cert/certvaLasp or by calling (888) 875-5790 VALIDATION NUMBER: 58468652 R£CEZV£D ~,~, _~1~ SSL7655816 fqCCARTHY RFbCL. ESTATE ~r 15 2Bi3 !5;Z&:3~ E~? ?R~; PZ~/177i~961893 ~SB~ 13171953-BB6-1 Pi~iB ~ JIF B[~3 CERTL~'ICATI~ 0,3 INg~LRANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW i P,'-, ¢::[' L 2 c be ccm~;;j! l~',:.,~Di~!)i_jii_,t,~ i~:xefit~ Carrk~r t r L;~ascd l~sur~ce Agent offal Carrier M. CCART~y MANAGEMENT tNC. $OUTHHOLB, NY 11971 Lb, ',¢u-5itloss'foi~pbon~ Numt~r of 6~ 1-765-5815 NYS Ur~mploym~t lnsuran~ Employer ReoJstfatitm 1231151 THE TOWN OF SOUTNIiOL:) t$UILI;iNG DEPARTMENT SOU'~iiOLD, N'I' 1197} Bt. RI'FORD LIFE INSURANCE CO. 3b, ,"o:i~y Nana"n:r ot'o. Oly listcd lit trax "la": LNY-195318 3c. Pci~c9 otl~d~fiod: Addifio.,~d Instructions fbr. orm DB-]20. ~. ~ss'oe s~y i>,~':m~ for ~r in cz, v~:on u,,~5: ~nv work mvoiviag ~he emoloym~t of ~ploy~ in empl~t ~ s~usfaelo~y ro me cha~[ ri-m: *i~ p~menr ofdisabi!ity bcnefim i~or all ~ploy~ h~ ~ a~u~ ~ ~id~ ~ [his article Nothing he~e~.:, howe%:' ~'~a;~ be co:~stTucd ~$ .:::e:mng an3 tiabi!i~ on ~e ~n of s~ sm~ ~ ReceiptCopy Page 3 of 3 SUFFOLK COUNTY OFFICE OF CONSUMER AFFAIRS PAYMENT RECEIPT RECEIPT NO. 265663 MCCARTHY MANAGEMENT INC 46520 COUNTY ROAD 48 SOUTHOLD NY 11971 Rec'd From: D/B/A: Date: T MCCARTHY MCCARTHY MANAGEMENT INC 11/07/2012 Payment Type: No: Drawn On: CHECK 8013 BRIDGEHAMPTON NATIONAL BANK Category Service Fee Violation Slip No Remarks 5 - H.I. Contractor C - Lic. Renew. $400.00 REC'D BY: _icenee~ I Registration#: JTA ~5254 TOTAL: Remarks: ;400.00 LATE FEE WAIVED PER CL ATTENTION HOME IMPROVEMENT CONTRACTORS Suffolk County Code Chapter 345-17 (D) states: All advertising for Home Improvement contracting shall contain the number of the Home Improvement license. Customer copy NOTE: PLEASE SIGN SIGNATURE STRIP ON BACK OF ID CARD! http://suffolkca/receiptcopy.aspx?ID=263663 11/7/2012 TO 46520 COUNTY ROAD 48 SOUTHOLD, NY 11971 WE ARE SENDING YOU [] Attached [] Under separate cover via [] Shop drawings [] Prints [] Plans ,] Copy of letter [] Change order [] [] Samples the following items: [] Specifications THESE ARE TRANSMITFED as checked below: r 1 For approval [3 For your use r ! As requested I i For review and comment ~3 FOR BIDS DUE Approved as submitted Approved as noted Returned for corrections Resubmit Submit Return copies for approval copies for distribution corrected prints PRINTS RETURNED AFTER LOAN TO US REMARKS 3PY TO SIGNED: If enclosures are not as noted, kindly notify us at once. PATIO EXISTING DEN F EXISTING DINING EXISTING KITCHEN CEILING 4: STRUCTURE TO REMAIN A'. IN ALL AREAS LIVING AREAS TO~ REMAIN AS EXISTING ENTRY STOOP FIRST PLOOR LAYOUT SCALE. ¼"= ILO'' 4"¢ ROOF VENT 4 ~,ITCHEN LAUNDRY BATH I ~ATId 2 c.oJ~ ~ x ~ ~" c,~ 5LOP~" U4" PE~ FOOT PITCH TO DRAIN PECK PLACE RANCH BATH HALL BEDROOM EXISTING TO REMAIN ] GLOD~T EXISTING MASTER BEDROOM EXISTING TO REMAIN BEDROOM EXISTING TO REMAIN WALL LEGEND: W'ALL TO P~EMAIN WALLTO BE REMOVED 2013 GEIEP. AL NOTE5: PLLMBING ¢ HVAC NOTES: ELECTRICAL NIOTES: ORIGINAL LAYOUT NO 5GALE PRAMING NOTES: PLOOR PLAN' NOTES: PAGE: