HomeMy WebLinkAbout38334-Z ----- - -- ---
Town
----Town of Southold Annex 9/25/2013
P.O. Box 1179
54375 Main Road
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 36524 Date: 9/25/2013
THIS CERTIFIES that the building ALTERATION
Location of Property: 230 Old Shipyard Rd, Southold,
SCTM #: 473889 Sec/Block/Lot: 64.-2-50
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/11/2013 pursuant to which Building Permit No. 38334 dated 9/18/2013
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"alterations to an existing single family dwelling as applied for
The certificate is issued to Conklin, Michael &Conklin, Patrice
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED 9/13/13 William Gremler
Aut ed tgnatur
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#: 38334 Date: 9/18/2013
Permission is hereby granted to:
Conklin, Michael & Conklin, Patrice
230 Old Shipyard Ln
Southold, NY 11971
To: "As built" alterations to an existing single family dwelling as applied for.
At premises located at:
230 Old Shipyard Rd, Southold
SCTM # 473889
Sec/Block/Lot# 64.-2-50
Pursuant to application dated 9/11/2013 and approved by the Building Inspector.
To expire on 3/20/2015.
Fees:
CO - ALTERATION TO DWELLING $50.00
AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $810.40
Total: $860.40
i"
Bw ding Inspector
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:
I. 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. Swom statement from plumber certifying that the solder used in system contains less than 2/10 of I% 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. If a 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
Dat/e.
New Construction: Old or Pre-existing Building: L"",
" (check one)
Location of Property: 230 dliZ) 3,4 �lpylt&l) A—I%V£ SCV7eL,0
House No. Street Hamlet
Owner or Owners of Property: 09A-7p /C't oeFUeL11"l
Suffolk County Tax Map No 1000, Section_CZ4 Block Lot 5-0
Subdivision Filed Map. Lot:
Permit No. $ Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $
Applic t Signature
�o�apF SQ(/pho�
Town Hall Annex Telephone(631)765-1%02
54375 Main Road Fax (631)765-9502
P.O.Box 1179 • ��
Southold,New York 11971-0959
Cou
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date:
Building Permit No.
Owner: I�tGOUNt, `7 (CL CCk-y—t-I J
j `(Please print) (y
Plumber:
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of I%
lead.
(Plumbers Signature)
Swornto before me this 115rz
day of `®J 20
STEVEN J 613
CH
Notary Public,State of New York
No.01AN81401740173
Qualified in Suffolk County 1,/L
ommission Expires January 23,20!I
Notary Public, County
*�zf S0V%
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUG LEIG.
[ ] FOUNDATION 2ND [ ] i LATION
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR
• n c i
®■moi .moi
r
h
, , .
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 3 sets of Building Plans
TEL: 765-1802Q Survey
PERMIT NO. Check
Septic Form
N.Y.S.D.E.C. _
Trustees
Examined 12043 Contact:
Approved 20 Mail to:
Disapproved a/c
Phone:
But tng nspe Lr
APPLICATION FOR BUILDING PERMIT
\ 145 8 U/ / (/ Date �d 20 /2
/ INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 a Certificate of Occupancy is
issued by the Building Inspector.
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
appligant�grws to comp�y wable laws, ordinances, building code, housing code, and regulations, and to admit
authorize�� tbrs n rebuilding for necessary inspections.
I J L l SEP 1 0 2
(Signature of applicant or name, if a co poratio�)/���
(2d �dv /(72 11A- ix64r�1
------7 (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
14&Fy /
� � �A /CF' 0,0 t1J �L/A-)Name of owner of premises I C rr�-/�}'L
(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.
1. Location of land on which prop ed wor will be don
2 '0 bU S1,4y�,0 AAti,9 AV
House Number Street Hamlet
County Tax Map No. 1000 SectionQ Block 2— Lot
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy _ 04.1 F/49U1/Ly
b. Intended use and occupancy
3. Nature of work (check: which applicable): New Building Addition Alteration _
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
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 R — 1/_/0
12. Does proposed constriction violaate� Tany zoning law, ordinance or regulation:
13. Will lot be re-graded_ Will excess fill be removed from premises: YES Nb
14. Names of Owner of premises C OIVIZI—IA I Address ? 30 0Lb SV"% one No. �-
Name of Architect_ Address Phone No
Name of Contractor_ Address Phone No.
15. Is this property within 100 feet of a tidal wetland? *YES 0
• IF YES, SOUTHOLD TOWN TRUSTEES 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.
STATE OF NEW YORK)
SS:
COUNTY OF )
{�_�being duly sworn, deposes and says that(s)he is the applicant
(Name of individuhigning con t above na d,
(S)He is the RlF/nI7_
(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.tp before me this
1 b day of 20j_�_
v� Pt6UdN
Notary Public S ature of Appli ant
CONNIE D. BUNCH
Nntary Public, Stat;of Nev,!Ycri(
No. 01 81J61
Duan fled in S,Jsiolt c, aty
commi"OnF:i,2�)
OF SO�lyo�
Town Hall Amex All Telephone(631)765-1802
co
54375 Main Road 61)�7.g6�5p-22�
P.O.Box 1179 roner.riche rtldtONR S076UWO f1 nV us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: D J<lit/n�UZ7� �S� Date:
Company Name:
Name:
License No.:
Address:
Phone No.: �p3�
JOBSITE INFORMATION: (*Indicates required information)
*Name: 0 e A4 IC ' eL/Aj
*Address: Z 3 0 (J(_l SFl£ X Lff/�7S
*Cross Street:
*Phone No.: (/31 6FQ //C-:�
Permit No.:
Tax Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
tLILI
P h l,t�
(Please Circle All That Apply)
*Is job ready for inspection: YE / NO Rough in Final
*Do you need a Temp Certificate: YES /�O
Temp Information(if needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form
s.. TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET 2 �`�,' VILLA E DISTRICT SUB. LOT 7 y
! /, /
b RMER OWNER //��,," N/ E ACREAGE
Q o ac44n A J X
Eugene shoer7 r^ S W TYPE OF BUILDING ( i
RES. SEAS. VL. FARM COMA. IND. CB. MISC.
�-io I I _
LAND IMP. TOTAL DATE REMARKS
67) hra/o o Dov
4 o v 0� .!�/v
Zra
Pao y6 00 Syo0
B N�i11 97
NEW NORMAL BELOW ABOVE �p „
S'
Farm Ache Value Per Acre Value
Tillable 1
Tillable 2
Tillable. 3
Woodland
Swampland
Brushlond
House Plot
n.
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Extension � m�' �C Both
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rIpExtension ..
Ext. WallsInterior Finish
te
Extension
Fire Place Heat
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PLUMSEi Cc TIFICATION toE V Pt1(lS F 001 L Ayo�� PLAT
'rEr., AS
ON LEA DCONTENT BEFORE PL! ;'IABING --�
APPV.. CU SHEET NO. Op
I,` ' L RTIFICATE OF OCCUPAN ALL P'. � "!NG WASTE
O _ g�(�ip..�R LINES NEED CALCULATED EY DATE
DATE: 13 PP. _ � � SOLDER USED IN WATE' TESTING BEFORE COVERING
EE SUPP Y SYSTEM CANS' CHECKED EY DATE _
NOTI Bu+t 4'c JT AT EXCEED 2110 OF1% LE 'r SCALE IJP' 1�2
765-1802 8 AM r. kGR THE
FOLLOWING INSPEC f I ,'S: 20'-3°
1. FOUNDATION - Tit" ,FOUIRED
FOP, POURED CCrJCHE1E rpLQn
2. ROUGH - FRAM NG & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCT!ON MUST
BE COMPLETE FOR C.G.
ALL CONSTRUCTION SHALL MEET THE u CL
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS. � ppM
N TUB (r
CON",--'y V11--H ALL CODES OF �
NEW Y,-Jr-K S ( ^, rc & TOWN CODE
AS REi�JIRED AM-,
Cr
S °Et
fn
CL _ LJ�DRCJOF�I 'i ,
dl r
CL.
)CCUPANCY OR '
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY -
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