HomeMy WebLinkAbout38664-Z
Town of Southold Annex 3/28/2014
P.O. Box 1179
54375 Main Road
!S Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 36825 Date: 3/27/2014
THIS CERTIFIES that the building ALTERATION
Location of Property: 950 Grange Rd, Southold,
SCTM 473889 Sec/Block/Lot: 75.-4-9
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/28/2014 pursuant to which Building Permit No. 38664 dated 2/6/2014
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:
MINOR ALTERATIONS. INCLUDING WINDOWS AND ENTRY STEPS TO A SINGLE FAMILY DWELLING
AS APPLIED FOR
The certificate is issued to Miller, Charlotte
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38664 03-20-2014
PLUMBERS CERTIFICATION DATED
Au o ed igat e
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 38664 Date: 216/2014
Permission is hereby granted to:
Miller, Charlotte
Carroll Ave
PO BOX 195
Peconic, NY 11958
To: construct minor alterations to include windows and a new set of entry steps as applied
for
At premises located at:
950 Grange Rd, Southold
SCTM # 473889
Sec/Block/Lot # 75.-4-9
Pursuant to application dated 1/28/2014 and approved by the Building Inspector.
To expire on 8/8/2015.
Fees:
SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $200.00
CO - ALTERATION TO DWELLING $50.00
Total: $250.00
Building 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. 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. 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
Date. 7:5'C, 2-0 11
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 1507 Cr??L9P So~~~~
House No. Stree Hamlet
Owner or Owners of Property: C1-,0,(, k 00T /M\1 ~~Oc
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Perin itNo. Date ofPermit._ _Applicant: ~ &Af-Y
r
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: _ (check one)
Fee Submitted: $ $p
Applicant . ignature
pf SOUI'yo
Town Hall Annex Telephone (631) 765-1802
54375 Main Road T Fax (631) 765-9502
P.O. Box 1179 c o roger. richerKaDtown.Southold. nv.us
Southold, NY 11971-0959
~yCoW
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Miller
Address: 950 Granger Rd City: Southold St: NY Zip: 11971
Building Permit#: 3s( (oq Section: 75 Block: 4 Lot: 9
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: STS Electric License No: 41857-me
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor 1st Floor X Pool
New Renovation X 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 4 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures 1 CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpl Emergency Fixture Time Clocks
Disconnect Switches 3 Twist Lock Exit Fixtures TVSS
Other Equipment: 1-exhaust fan
Notes:
Inspector Signature:- Date: March 20 2014
81-Cert Electrical Compliance Form.xls
o~yOF 8W/l~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL)
REMARKS:
DATE Zts INSPECTOR
o~v OF SW,*,
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST [ ] RO H PLEIG.
[ ] FOUNDATION 2ND [ ] I ULATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR]
FIELD INUSCITON99MIEV DATE COMMENTS
ro
FOUNDATION (1ST)
~qu
. FOUNDATION (2ND)
z
~o
ROUGH FRAXWQ &
PLUMMG
INSULATION FERN. Y.
STATE ENERGY CODE
3 .
-41 -4-77Z
FINAL
ADDMONAL COMMENTS
T- 74 0, 7, rx 77-7 7777 <74s 767
C
X
~x
~b
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 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 p p^ Survey
SoutholdTown.NorthFork.net PERMIT NO. 3 (Y Check2oC. '-jw
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined, 204- Storm-Water Assessment Form
Contact:
Approved, 20-1~ Mail to:
Disapproved a/c~TT~ ~-t 11
Phone: (,o
Expiration , 20
Building Inspector
]scale. LICATION FOR BUILDING PERMIT
JAN 8 2014 Date Sri 20 111
INSTRUCTIONS
a. This applibaOian i'~$T etely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets 01,640S,acsMrate- p an to 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.
{ 'q (Signature of ap cant or name, if a corporation)
I , i F~ 3<x k~i ~~~12 NY [(061
t , r7 + + (Mailing address o applicant)
, APPROVED AS NO-
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrrcran, p umber or builder
I DATE:-B.P. # 30l
~pp_~ r~E: By _
Name of owner of premises l1Y Y ~ot t~\eT' NOTIFY BUILDING DEPARTMENT F
(As on the tax roll or la THE
If applicant is a corporation, signature of duly authorized officer G INSPECTIONS:
Y I. FOUNDATION -TWO REQUIRED
FOR POURED CONCRETE
(Name and title of corporate officer) 2. ROUGH - FRAMING, PLUMBING,
STRAPPING, ELECTRICAL & CAULKING
Builders License No. ~\bc65 3. INSULATION
4. FINAL - CONSTRUCTION&ELECTRICAL
Plumbers License No. MUST BE COMPLETE FOR C.O.
Electricians License No. ALL CONSTRUCTION SHALL MEET THE
Other Trade's License No. REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
1. Location of land on which proposed work will be done: DESIGN OR CONSTRUCTION ERRORS.
Isc7 (ten SaJ~ V
House Number Street 1 Hamlet c~
County Tax Map No. 1000 Section /S Block Lot /
Subdivision Filed Map+No. Lot
2. State existing use and occupancy of premises and intended use and occupanc"y~ of proposed construction:
a. Existing use and occupancy S zno le ~er.U'vt\ti I Y P S t ~
b. Intended use and occupancy S~ 1 °j vl ~Y f~31
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work Iwo Ne„~ 5f11yI
(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 r Depth I,
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 Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15. a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO YN,
YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BF REQUIRED.
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)
SS:
COUNTY OF )
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 t efore me th'
a day of 201~- j
liter r-? C
Notary Public E D. BUNCH Signatu o Applicant
Notary Public, State of New York
No. 018118195060
QuaNBad In &dloet County
Commission Expires April 14, 2g_u
Scott A. Russell '01- James A. Richter, R.A.
SUPERVISOR _ Michael M. Collins, P.E.
SOUTHOLD TOWN HALL - P. O. Box 1179 53095 Main Road - SOUTHOLD, NEW YORK 11971
Telephone (631) - 765 -1560 Fax (631) - 765 - 9015
MICHAEL.COLLINS@TOWN.SOUTHOLD.NY.US Ol •~T' JAMIE.RICHTER®TOWN.SOUTHOLD.NY.US
Office of the Engineer
Town of Southold
STORMWATER MANAGEMENT CONTROL PLAN REVIEW COVER SHEET
(TO BE COMPLETED BY THE APPLICANT)
PLEASE NOTE: All Contact & Project Information Requested by this FORM is Nessary for a Complete Application.
APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) PROPERTY OWNER: (If Different from Applicant)
NAME: ~/tr'~P/ ell eronz NAME: "Ilex
ADDRESS: 3% (_PL'A C-• L-, ADDRESS: D e fl
lvedgje ~f (()SI S'ia Q 1197(
Telephone Number: 31 3 S 0,k`'(( Telephone Number:
Completed Applications can be picked up at the Engineering Department after being notified by the Department, or;
it can be Mailed to the Applicant with the submission of a Self Addressed 8.5' x I F Envelope & Appropriate Postage.
DATE: Property Address / Location of Construction Work:
~r 6se KJ
SCTM#: 1000
District Section Block Lot
Required Documents for Stormwater Review:
Copy of Complete Building Permit Application.
Stormwater Management Control Plan. (2 Sets)
Note: SMCP's are required whenever Grading or Excavations exceed 5,000 S.F, when New Impervious Surfaces are
created, and/or when existing Roof Systems, Driveways, Patios or other Impervious Surfaces are Re-Surfaced.
De Minimis Projects will NOT be Subject to the Submission of a SMCP During the Stormwater Review!
Note: These Projects would be Limited to Interior Renovations, Replacement of exterior Doors & Windows, Deck Construction
with Loose Fit Decking, Installation and/or Modification of Mechanical Systems or other similar Work.
A Complete Description of the Scope of Work Proposed under the Building Permit Application.
A Completed Storm "r Review ec ist. If No or NA are Indicated, Justification is Required.
'FORE G E G DEPARTMENT USE ONLY
Reviewed By: Date: z r f
App oved:
Add it nal Information Required:
FORM # SMCP - TOS JAN 2014
CHAPTER 236
STORMWATER MANAGEMENT CONTROL PLAN CHECK LIST
Z DATE: APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other)
0 S C T M 1000 NAME:
Ol District Section Block Lot Telephone Number:
S M C P - Plan Requirements: The applicant must provide a Complete Explanation and/or validation of all Information Required by this Checklist if it has not been provided!
1. A Site Plan drawn to scale Not Less that 60' to the inch MUST If You answered No or NA to any Item, Please Provide Justification Here!
NA
show all of the following items: YE NO If you need additional room for explanations, Please Provide additional Paper.
a. Location & Description of Property Boundaries
b. Total Site Acreage.
c. Existing - Natural & Man Made Features within 500 L.F. O~ P/19~ gtt 7}' l.~
of the Site Boundary as required by § 236-17(Cx2).
d. Test Hole Data Indicating Soil Characteristics & Depth to Ground Water.
e. Limits of Clearing & Area of Proposed Land Disturbance.
f. Existing & Proposed Contours of the Site (Minimum Z Intervals) 0~
g. Location of all existing & proposed structures, roads,
driveways, sidewalks, drainage improvements & utilities.
It. Spot Grades & Finish Floor Elevations for all existing &
proposed structures.
1. Location of proposed Swimming Pool and discharge ring.
j. Location of proposed Soil Stockpile Area(s).
k. Location of proposed Construction Entrance/Staging Area(s). 0
1. Location of proposed concrete washout area(s).
M. Location of all proposed erosion & sediment control measures.
2. Stormwater Management Control Plan must include Calculations showing
that the stormwater improvements are sized to capture, store, and infiltrate
on-site the run-off from all impervious surfaces generated by a two (21 inch
rainfall / storm event.
3. Details & Sectional Drawings for stormwater practices are required for approval.
Items requiring details shall include but not be limited to: include but not be limited to:
a. Erosion & Sediment Controls.
b. Construction Entrance & Site Access.
c. Inlet Drainage Structures (e.g. catch hasins, trench drains, etc.)
d. Leaching Structures (e.g. infiltration hasins, swales, etc.)
FO SWCP Check List - T JAN 2014
i
~oLOF SOfjr~<o
Town Hall Annex Jr1 Telephone (631) 765-1802 >
59375 Main Road ?r (631) 7g5
P.O. Boar 1179 ] • ronecrichert&wn.souUlopg
ltl.ny us
Southold, NY 11971-0959 a
+
BUILDING DEPAIC114 YN'r
TOWN OF SOUTHOLD j
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: ?1 Date:
Company Name: 1!7-U r
Name: n3
License No.: - m
Address:
Phone No.:
JOBSITE WFORMATION: ("Indicates required information)
*Name:
*Address: Ti6 (,r( v o j
*Cross Street: Ul j
*Phone No.: 631 - 35?- V, ta,tf"kc a
Permit No.: AP- 3R(
, b
Tax Map District: 1000 Section= 6 Block: Lot: 9
i
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) ~ hdd /I,µ.l ck4 *sj-
&A) t :tio-.-ez C j . Aplsu eW~-7
I
(Please Circle All That Apply)
*Is job ready for inspection: YES NO Rough In Final
*Do you need a Temp Certificate: /1 O
'temp Information (If needed)
*Service Size: 1 Phase Whase 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
B2 Request for Inspection Form G -1 b 7~
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Well shown SUFFOLK COUNTY DEPARTMENT HEALTH SERVICES
o~ j%o[ map FOR APPMDVAL OF CONSTRUCTION ONLY
N n DATE ft REF. NO. 92-SO-61
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P/0 LOT 12 r^ -
AREA = 16,259 sq. I1..
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SOUTH HARBOR HOMES I,'
ELEVATIONS ARE REFERENCED FILED JULY 14, 1964 FILE NO. 40 6
To AN ASSUMED DA TGIF AT SOU T H O L D NOV
CERTIFIED TO: TOWN OF SOUTHOLD
CHARLOTTE ANN MILLER S.G. f,t
U.S.D.A. FARMERS HOME SUFFOLK COUNTY N. Y. HEr1Li~1
ADM~'V/STRA TION 1000 0 75 - 04 - 09 SECURITY TITLE 8 GUARANTY CO.
(S-107-02- 701 SCALE I"=30' OqT, 1,!992 ffoundallonl
JUNE 3, 1986 MO v 1 T,1992ffinall
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JUNE 19,!986
JUNE 4, 1992
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standards for !ilia surveys as established
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AIAMCNJN. n Title Assoclallon.
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