HomeMy WebLinkAbout38861-Z 4 Town of Southold Annex 10/10/2014
P.O.Box 1179
54375 Main Road
i�� Southold,New York 11971
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CERTIFICATE OF OCCUPANCY
No: 37203 Date: 10/10/2014
THIS CERTIFIES that the building ALTERATION
Location of Property: 1275 Fanning Rd,New Suffolk,
SCTM#: 473889 Sec/Block/Lot: 117.-4-30
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
4/29/2014 pursuant to which Building Permit No. 38861 dated 5/7/2014
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:
interior alterations to an existing dwelling as applied for.
The certificate is issued to Meisel,Anthony C.
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38861 7/21/2014
PLUMBERS CERTIFICATION DATED 10/6/2014 William Gremler
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Author( ignature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
' SOUTHOLD, NY
1 �
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#: 38861 Date: 5/7/2014
Permission is hereby granted to:
Meisel, Anthony C.
227 Park Ave
Hoboken, NJ 07030
To: interior alterations to an existing dwelling as applied for
At premises located at:
1275 Fanning Rd, New Suffolk
SCTM # 473889
Sec/Block/Lot# 117.4-30
Pursuant to application dated 4/29/2014 and approved by the Building Inspector.
To expire on 11/6/2015.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $257.60
CO -ALTERATION TO DWELLING $50.00
Total: $307.60
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:
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. 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
1. 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$15.00
Date. 2014
New Construction: k Old or Pre-existing Building: (check one)
Location of Property: 1 `2 �� S) t✓
House No. Street Hamlet
Owner or Owners of Property: y �-' M
Suffolk County Tax Map No 1000, Section �� Block Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$
Applicant Signatur
SO(/TyQI,
Town Hall Annex Telephone(631)765-1802
54375 Main Road 4 Fax(631)765-9502
P.O.Box 1179 CIO
Southold,NY 119711-0959 Q roper.riche rt(aD-town.southoId.ny.us
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Meisel
Address: 1275 Fanning Rd City: New Suffolk St: NY Zip: 11956
Building Permit#: 38861 Section: 1 1 7 Block: 4 Lot: 30
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Big Blue Electric License No: 35348-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 2 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks
Disconnect Switches F]3 Twist Lock Exit Fixtures TVSS
Other Equipment:
Notes:
Inspector Signature: Date: July 21 2014
81-Cert Electrical Compliance Form.xls
Skop SU(/Tyo
Town Hall Annex Telephone(631)-7654902
54375 Main Road '�' �" Fax(631):765-9502
P.O.Box 1179
Southold,New York 11971-0959 • �Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
-CERTIFICATION -
Date:
CERTIFICATIONDate: Q
Building Permit No.
Owner: 0
(Please print)
Plumber:
(Please print)
I certify that the solder used in.the water supply system contains less.than 2/10 of 1°lo.
lead.
(Plumbers Signature)
Sworn to before me this
day of 20
_Lq
BONNIE D.BUNCH
Notary Public,State of New York
No. 8505
O��alified in in Suffolk County
commission Expires April 14,2-
Notary Publi6-4County
1 of So�
"' oy►� Typ
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ROUGH PLUMBING
[ ] F NDATION 2ND [ ] INSULATION
[ FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATIO [ ] CAULKI
REMARKS: r Q
DATE '0710_7A4 INSPECTOR
i
Of SO(/lyo�
(� couNn,`
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLUMBING
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE INSPECTOR
�' o��OG SOUT,yO
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING
[ ] FOUNDATION 2ND [ ] "LATION
[ ]
FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS: v
DATE 07AINSPECTOR
t�
PLUNMING
INSULATION
STATE ENERGY CODE
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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 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood Permit
Examined 5`/7,20A Single&Separate
Storm-Water Assessment Form
Contact:
Approved 20 Mail to:11m,"y LtYZ
Disapproved a/c pb, Dtc 1 692 , �,Tn
Phone:
Expiration fl -7 20
Building Inspector
J APA A,4 .ICATION FOR BUILDING PERMIT
� Date L �-`� ,20_t+
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 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 egulations, and to admit
authorized inspectors on premises and in building for necessary inspections. q_k
ignature of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nf?= 1
Name of owner of premisesNbN
(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. P(p I N!l
Plumbers License No. '
Electricians License No. M
Other Trade's License No.
1. Location of land on which proposed work will be done:
12-15 OLA:-
House Number Street Hamlet
County Tax Map No. 1000 Section Block 4 Lot
Subdivision Filed Map No. Lot
t
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy SI nl G� �q'n j 4.Y f>/yg.rrjNG
b. Intended use and occupancy SS7py
3. Nature of work (check which applicable): New Building Addition Alteration 1C
Repair Removal Demolition Other Work kjrf✓ l O�.
(Description)
4. Estimated Cost-$`a ow 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 5t 2- Rear 52 Depth 2fo 1
Height Number of Stories !
Dimensions of same structure with alterations or additions: Front '� Rear
Depth 2-6 ' Height 16 ` Number of Stories i
8. Dimensions of entire new construction: Front �,` �R Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase 5/1 bw 3 Name of Former Owner `-j
11. Zone or use district in which premises are situated P,40
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X
13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO
17-11, faIM41 R0
14. Names of Owner of premises QNjQ oNq j1t��.+SAddress Neal SuFFet-K- Phone No. 7 S6
34-
Name of Architect DON kW r-t_: t 1,-E L Address r Yy-T i jQCdg_ Phone No ZG16 -S-f'5 3
Name of Contractor FAN 01 N!�j Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO k
* 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.
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.
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01SU6185060
COUNTY OF ) commissiondin a
ExpiesApril 14 2-1::Ll
I L being duly sworn, deposes and says that(s)he is the applicant
(Name of individ lal signing contract)above named,
(S)He is the P.:Pzo
(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
Gi day of 1 20 J
Notary Public ignatu Applicant
Town Hall Annex 1 Road 41 Telephone(3631)765-1802
P.O.Box 1179 • gerAchedd 1SOU�.t1Y.Us
Southold,IVY 11971-0959
BunDINc-DEPARTII wr
TOWN OF SOVTHOLD
APPLICATION FOR ELECTRICAL. INSPECTION
F
QUESTED BY "�7 T�l��.�c Cz`l-Gct�s c l f C Date:mpany Name: �j < i 1(,,e ec irne:
License No.: 3
Address: `o a (.y �- i i 7` - v /I r z.
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: f_2j-, ;S¢: -
*Address: l ZU
T
*Cross Street:
*Phone No.:
Permit No.: ��b!
Tax-Map District: - 1000 Section: Blodc Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
19A ZOO,(,
(Please Circle All That Apply)
*Is job ready for irxspeton: Q�YE / NO Rough In) Final
"do-you need a Temp Certificate: YES/ NO
Temp Intimnadott(if-needed) .
*Service Size: 1 Phase 313hase 100 150 200 300 350 400 Other
*New Service: Re-Qonnect" Underground Number of Meters Change of Service Overhad c f p1
Additional Information: PAYMENT DUE-WITH APPLICATION �
.8241equest for Inspection Fomt
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• T. TERRY I �k - '� '� Tn •n Il,rll. S llluS Ala►►►
Y�. P.o. nr,r I17o
f fi0N11 CLERK `:.,��� -: Srrulbohl. Nc�• _Turk 1
Fax (5 161 765.I R`.�
pEC;,SfRAR OF v1TA1.STAT1511C5Tc
MARRIAGr•, OFFICCR _ kRlrunc t�Ih1 )(rt_
RECORDS MANAGEMENTOFFICEII �O1 : A I
i
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993:
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under the Flood Damage Prevent. regulations
of the Code of the Town of Southold: "Floodplain Development. Permit
!application" (FDP(93)) , and ';Certificate of Compliance fySr Oevell6ment in
Special Flood Hazard Area (C/C(93)] .
• t�LJV. UcrT .�_.
TOVA';4 OF SOUP-101-D
Ah T. Terry
Southold Town Clerk
August 25 , 1993
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APPLICATION
r
PAGE 1 0( 4
TOWN OF SOUTHOL.D
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate.
SECTION 1 GENERAL PROVISIONS (APPLICANT to read and sien):
1. No work may start until a permit is issued.
2 The permit may be revoked if any false statements are made herein.
3. If revoked, all work must cease until permit is re=issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
S. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory
requirements.
7. Applicant hereby gives consent to the Local Administrator-or his/her representative to make reasonable
inspections required to verify compliance.
8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO
_ THIS APPLICATION ARE,TO THE B OF MY WLEDG UE AND ACCURATE.
(APPLICANT'S SIGNATURE) DATE Ct7
i
/r c com icted by APPLICAh'n
/SECTION 2: PROPOSED DEVELOpF�'7ENT p
NAME ADDRESS TELI✓P.
APPLICANT
BUILDER C 11
ENGINEER r
PROJECT LOCATION:
• To avoid delay in processing the appbca6oa, please provide enough information to easily identify the project
location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or well-known landmark A sketch attached to this application sbowing
the project location would be helpful.
FDP(93)
APPLICATION
PAGE 2OF4
DESCRIPTION OF WORK (Check all appUcable boxes):
A. STRUCTURAL DEVELOPMENT
ACTIVITY STRUCTURE TYPE
O New Structure @'Residential (14 Family)
O Addition O'Residential (More lbain 4 Family)
W--%Iteratioo ❑ Noo-residential (FloodprooCtng? O Yes)
❑ Relocation O Combined Use (Residential & Commercial)
Cl DemdUtioo, ' P O Manufactured (Mobile) Home (In Manu-
0 Replacement factured Home Park?. D Yes)
ESTIMATED COST OF PROJECT S '6S7e 0-0-D
B. OTHER DEVELOPMENT ACTIVITIES:
O Fill O Mining 0 Drilling O Grading
O Excavation (Except for Structural Development Checked Above)
O Watercourse Alteration (Including Drcdging and Channel Modifications)
O Drainage Improvements (Including Culvert Work)
j O Roar, Street or Bridge Construction j
/ O SU ' ion (New or Expansion)
/ ❑ 1
phividual Water or Sewer System
G Other (Please Specify)
After completing SECTION 2, APPLICANT should submit form to Local Administrator for review.
SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR)
The proposcd development is located on FIRM Panel No. . Dated
The Proposed Development:
O Is LQT located in a Special Flood Hazard Arca (Notify the appUca.nt that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
O Is located in a Special Flood Hazard Arca.
FIRM zone designation is
loo-Year flood elevation at the site is.` H. NGVD (MSL)
O Unavailable
❑ The proposcd development is located io a floodway.
FBFM Pancl No. Datcd
O See Section 4 (or additional instructions
SIGNED DATE
APPLICATION #
PAGE 3 OF 4
SECTION 4 ADDITIONAL INFORMATION REQUIRED (To he completed by LOCAL ADMINIS`C'RATOR)
The appbcant must submit the documents checked below before the appbcation can be processed:
❑ A site plan showing the location of all cnsLwg structures, water bodies, adjacent roads, lot
dimensions and proposed developmcot.
O Development plans,drawn to scale, and spccifncatipns,including where applicable: details for
anchoring structures, proposed elevation of lowest floor(including basement), types of water
resistant materials used below the first floor, details of floodproofwg of utilities located below
We first floor and details of enclosures below the first floor.
Also
O Subdivision or other development plans (If the subdivision or other development exceeds 50
lots or 5 acres,whichever is the lesser, the applicant must provide loo-year flood elevations
if they are not otherwise available).
O Plans showing the extent of watercourse relocation and/or landform alterations-
0 Top of new fill elevation Ft. NGVD (MSL).
❑ Floodproofu,g protection.,leve) (non-residential only) Ft:NGVD (MSL). For
floodproofed structures, 1ppGcant must attach certification from r-gistered engineer or
architect.
❑ Certification from a"regis tered engineer that the proposed activitj in a regulatory floodway
will not result. in;any increase in the height of the 100-year flood. A copy of all data and
calculations supporting this finding must also be submitted.
❑ Other.
SECTION 5: PERMIT DETERMINATE N fTQbc completed by LQkAL ADMIN[ RAT R
I have determined that the proposed activity'. A-❑ Is
B. O Is not
in conformance with provisions of Local Law if , 19_. The permit is issued subject to the conditions
attached to and made part of this permit.
SIGNED DATE
If BOX A is checked, the Local Admiautrator may issue a Dcvelopmenl Permit upon payancnl of designated
fee.
If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may
revise and resubmit an application to the Local Administrator or may request a bearing from the Board of
Appeals.
• APPLICATION �+
PAGE 4 OF 4
APPEALS: Appca►cd to board of Appeals? O Yes O No
Hearing date:
Appeals ---
Appioved? E3 Yes 9 NO
Conditions
SECTION 6 AS BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance
is issued
The following information must be provided for project structures. This section must be completed by a
registered profcssioga] engineer or a licensed land surveyor (or attach a certification to this application).
Complete 1 or 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor,including basement rn Coastat High Hazard
Areas• bottom of lowest structural member of the lowest floor, excluding piling and columns) is:
Fr. NGVD (MSL).
L Actual (As-Buil() Elevation of floodproofing protection is FT. NGVD (MSL).
NOT' Any work performed prior to submittal/bf the above information is at the risk of the Applicant.
SECTION 7 COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable, based on inspection of the project to
ensure compliance with the community's local law for flood damage prevention.
INSPECTIONS: DATE BY DEFICIENCIES? O YES O NO
DATE BY DEFICIENCIES? O YES 11 NO
DATE BY DEFICIENCIES? O YES Cl NO
SECTION 8 CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADNITNISTRATOR)
Certificate of Compliance issued: DATE: BY:
Attachment B
i SAMPLE
/ CERTIFj CATE %JF COMPLIANCE
al Flood Hazard Area
1 for Development in a Slpeci
, 1
, I
TOWN OF SOUTHOLD
CCRUFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
- (01AWEER MUST RETAIN THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
D NEW BUILDING
O E7(ISTING BUILDING
O VACANT LAND •'J
THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_.
SIGNED: DATED:
B. COMPLLANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # ,
DATED
SIGNED: DATED:
C /C ( 93 )
SO�Tyol.
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G •
Southold,NY 11971-0959
�DUNTY,�
October 8, 2014
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Anthony Meisel
PO Box 228
New Suffolk, NY 11956
TO WHOM IT MAY CONCERN:
The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy:
'Note: Building Inspector said he spoke to you about filling out the enclosed flood permi
application along with$100 fee required.
Application for Certificate of Occupancy. (Enclosed)
Electrical Underwriters Certificate.
A fee of$50.00.
Final Health Department Approval.
Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84)
Trustees Certificate of Compliance. (Town Trustees#765-1892)
Final Planning Board Approval. (Planning#765-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept.
Final Storm Water Runoff Approval from Town Engineer
BUILDING PERMIT — 38861 — Interior Alterations
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DATE rNidB.P.# .500 3"6yzHT
I' l FEE '1 U BY ! ALL PLUMPING WASTE
J �,'! �I l,^ DF_PARTMENT AT &WATER LIN'-'-,
NOTIFY _
755-1802 ".1 FOR THE M t:> "}'}
� 4 TESTlPYG $Ei=V"iE C'
FOLLOWIN. �V
1. FOUND �'� W SLUMBER CERTIFIo '
X1 �RN4' \1 LEAD CONTENT
STRAPPIN4, _ , uL'!,INu u 2� 1�I2'' �TIFICATE OF C��
3. INSULATION; OLDER USED Ir f
O 4. FINAL-CONSTRUC _".ECTRICAL
' MUST BE COMPLETE 'rO �k�T 144% SUPPLY SYSTEM �,,
--- TRUCTION SNti _T THE
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