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HomeMy WebLinkAbout38236-ZFOL,,, � Town of Southold 3/27/2015 P.O. Box 1179 53095 Main Rd ,+ Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37484 Date: 3/27/2015 THIS CERTIFIES that the building WINDOWS Location of Property: 1000 CR 48, Greenport, SCTM #: 473889 Sec/Block/Lot: 34.-4-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/29/2013 pursuant to which Building Permit No. 38236 dated 8/7/2013 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: TWO REPLACEMENT WINDOWS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Wylie Lanfray, Susan & Lanfray, Nestor (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 12 - 4, a 4��w 7ignaAu o ' ed t 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 #: 38236 Date: 8/7/2013 Permission is hereby granted to: Wylie Lanfray, Susan & Lanfray, Nestor 83 -85116th St Richmond Hill. NY 11418 To: install (2) replacement windows as applied for At premises located at: 1000 CR 48, Green SCTM # 473889 Sec/Block/Lot # 34.-4-2 Pursuant to application dated To expire on 2/6/2015. Fees: 7/29/2013 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $200.00 CO - ALTERATION TO DWELLING $50.00 Total: $250.00 , & �- --- - 6 �- . �” I 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. July 24, 2013 New Construction: Old or Pre-existing Building: X (check one) Location of Property: 1000 North Road Greenport House No. Street Hamlet Owner or Owners of Property: Nestor Lanfray Suffolk County Tax Map No 1000, Section 3� Block y Lot 0? Subdivision Filed Map. Lot: Permit No. Date of Permit.- %- /_3 Applicant: Rosalee Burgess- The Neher Group Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ 170 . ell Applicant Si&0ture 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined 2013 Approved 917 , 20 Disapproved a/c 13. Expiration 120 15 BUILDING PERMIT APPLICATION CHECKLIST PERMIT NO. ,3�d,3,b —building Inspector Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm -Water Assessment Form Contact: Mail to: The Neher Group 1239 Revere Drive, Chalfont, PA 18914 Phone: 215-716-3539 APPLICATION .FOR BUILDING PERMIT INSTRUCTIONS Date July 24 120 13 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. 4— - Rosalee Burgess (Signatu of applicant or name, if a corporation) 1239 Revere Drive, Chalfont, PA 18914 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contrAtdr,mgPiff"W§ Mtrh 9 or builder AGENT DATE LL�L_ B.P. # .22,` L_ Name of owner of premises Nestor FEE: �Z;,) ? BY --- Mr)TIFV RI III film. np. 1RTP.AP?-1 ` (As on the tax roll or la2eStt921) 8 AM TO 4 PM FOR If ap ' ant is a torpration, sig re of duly a thorized officer FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED e and title of corporate officer) FOR POURED CONCRETE 2. ROUGH -FRAMING, PLUMBING, Builders License No. 27587-H STRAPPING, ELECTRICAL & CAU�K'N(' 3. INSULATION Plumbers License No. N/A 4. FINAL - CONSTRUCTION & ELECTRICAL Electricians License No. N/A _ MUST BE COMPLETE FOR C.O. Other Trade's License No. N/A ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEV 1. Location of land on whichro osed work will be done: YORK STATE. NOT RESPONSIBLE FOP p p DESIGN OR C0NSTRV1'TIV,1 1000 North Road Greenport House Number Street Hamlet County Tax Map No. 1000 Section Block '�A Lot_ Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Single Family Residence b. Intended use and occupancy Single Family Residence Nature of work (check which applicable): New Building Addition, Repair X Removal Demolition Other Work - 4. Estimated Cost $1,180.00 Fee Alteration (Description) (To be paid on filing this application) If dwelling, number of dwelling units 1 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 Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories Dimensions of entire new construction: Front Rear Depth Height Number of Stories Size of lot: Front Rear. 10. Date of Purchase Name of Former Owner Depth 11. Zone or use district in which premises are situated f-mid-eAGA 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO x 13. Will lot be re -graded? YES NO x Will excess fill be removed from premises? YES NO x 14. Names of Owner of premises Nestor Lankay Address 1000 N. Rd, Greenport Phone No. 631-477-5094 Name of Architect N/A Address Phone No Name of Contractor THD At -Home Services Address 40 Oser Ayena ste 1zPhone No. 877-808-0050 Hauppauge, NY 11788 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NOS_ * 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 X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) 63aie& &fS being duly sworn, deposes and says that (s)he is the applicant (Name of individual si&ing contract) above named, (S)He is the 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 day of/—�- O -7 -.--- 20 /2 Not ry Public AMISS D. STEVENS Notary Public, State of New York Qualified In Bronx County Reg. No. 01ST6241005 My C0010118e10t E0108 05-09.2015 Signature o Applicant i Y I I AT � GE��NCC�F`T Turv/ O= Scx MA4,X—o , N. Y. �!:l. iF+; :I:w, /•!. L-L.'•I i.. f�j.•Y_ BJ�.[i . i /l-0 ,S` 1 YYY IA V v e- w FWNIgFRm AFIE9F,EroM 09 MO Sp Fo I«R slum R w Hound. N I � ` FIRrpM Iia 01 IMF IEW Y09c FI. { ! cuuenmrs W�I:.,:� MF1loal N„L _ CnIY IG In' ..::::I ill VIIIW In. - Cl 1. % <OK a.ur. �O1r-:✓.n.L:I�F AGF. i � IfNMry INa:ii.1:N Fl..i:•i A:xFOM, - .T ...D �I �` su FMF uxcn:�s of r.IF sFFm9+c sM - .n � I rvr:ox cuw9,wrtn �n MOI nwI _ ro +OunOMu MfnIN1oIFF w :Iw U G :ara. reed io Tht Trtk 6t.aram5r! Co: "L —, � ..�d lo 'max .50ufNo/d SaviN93 Hon Zooac_[GE' V4N7LYLFPC, 5co[e: 2�l' 4_ Lietvxrl6a.r�5ur✓. �owt CJ AIM. 5.64•�re'+'O' � — 5:7.0 . ✓✓M. POLL=2%' -4 ANO. tJ � ` STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a. Legal Name and Address of Insured (Use street address only) 1 b. Business Telephone Number of Insured (770)433-8211 THD AT-HOME SERVICES, INC. 1 c. NYS Unemployment Insurance Employer Registration DBA THE HOME DEPOT AT-HOME SERVICES Number of Insured 2455 PACES FERRY ROAD NW ATLANTA, GA 30339 1 d. Federal Employer Identification Number of Insured or Social Security Number 75-2698460 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) AETNA LIFE INSURANCE COMPANY TOWN OF SOUTHOLD 3b. Policy Number of entity listed in box "la": 53095 ROUTE 25 GS -839226-311 SOUTHOLD, NY 11971 3c. Policy effective period: 01/01/2013 to 01/01/2014 4. Policy covers: a. ® All of the employer's employees eligible under the New York Disability Benefits Law b. ❑ Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. da't� Date Signed July 2, 2013 By: (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number: (860) 273-1237 Title: Compliance Consultant IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. If box "4b" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the Disability Benefits Law. It must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, New York 12207. PART 2. To be completed by NYS Workers' Compensation Board (Only if box "4b" of Part 1 has been checked) State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers' Compensation Board Employee) Telephone Number Title_ Please Note: Onlv insurance carriers licensed to write NYS disability henefits insurance policies and NYS licensed insurance agents of'those insurance carriers are authorized to issue Form DB -120.1. Insurance brokers are NOT authorized to issue this form. DB -120.1 (5-06) STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured 770-433-8211 THD At -Home Services, Inc 2690 Cumberland Pkwy, Ste 300 1c. NYS Unemployment Insurance Employer Atlanta, GA 30339 Registration Number of Insured 45003895 Work Location of Insured (Only required if coverage is specifically Id. Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap -Up or Social Security Number Policy) 75-2698460 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) New Hampshire Insurance Company Town of Southold 3b. Policy Number of entity listed in box "la" 53095 Route 25 WC 033575314 Southold, NY 11971 3c. Policy effective period 03/01/2013 to 03/01/2014 3d. The Proprietor, Partners or Executive Officers are X included. (Only check box if all partners/ofilcers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "Ia" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "T'. . The Insurance Carrier will also not 6 the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certylicate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Approved by: Title: Jolui Clwistopher_ rin name of authorized representative or licensed agent of insurance carrier) 07/02/2013 (Signature) • (Bate) Attorney -in -Fact Telephone Number of authorized representative or licensed agent of insurance carrier: 770-670-2000 Please Note. Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us bearer is duly licensed by the County of Suffolk Clifford Coleman � SUFFOLK COUNTY DEPARTMENT OF CONSUMER AFFAIRS HO EIMPROVEMENT CONTRACTOR LICENSE 'Aw BOYD A LIPHAM ewfwmu wwk THD AT HOME SERVICES INC ATTN PEGGY PAYNE �c.vr rwme� 27587-H Dw`�au.e 09/1711999 exrsunEnw ogre 09/01/2013 To Whom It May Concern: This letter will authorize the following person(s) to act as agent(s) on behalf of THD At -Home Services, Inc., D/B/A The Home Depot At -Home Services 2690 Cumberland Parkway, Suite 300, Atlanta, GA 30339 to pull for permits and inspections I ith respect to the installation, maintenance and repair of windows, siding, roofing, gutters, entry doors and insulation. Authorized person(s): Stephanie Neher Rich Neher Jennifer Reynolds Rosalee Burgess Denise DePena Karis�sa DePena Charles Hickey, Sr. Compliance Manager THD At -Home Services, Inc. D/B/A The Home Depot At -Home Services STATE OF GEORGIA COUNTY COBB The foregoing instrument was acknowledged before me this 15th day of May, 2013 by Charles Hickey. Notary Pu is -State of Georgia Margaret Payne Printed Name: _1/21/14 My Commission Expires: Personally Known_x Or Produced Identification Type of Identification Produced � r (Seal) AVSLIG i ;'-'!Ry® 0f' �ossf� �i!F9N�5''''"� THD At -Home Services, Inc. Cumberland Office Park • 2690 Cumberland Pkwy, Suite 300 • Atlanta, GA 30339 Phone: 770-779-1300 • Toll Free: 877-469-0114 I e eher GROUP1239 Revere Drive • Chalfont, PA 18914 • Phone: 215.716.3539 Fax: 215.716.3543 247 N. Main Street • Red Lion, PA 17356 • Phone: 717.417.6678 • Fax: 717.417.6320 Inc. FOR ALL YOUR PERMITTING NEEDS July 24, 2013 Building Department Town of Southold 53095 Route 25 Southold, NY 11971 RE: Windows permit for the property located @ 1000 North Road, Greenport, NY 11944 Dear Sir/Madam: I have enclosed a completed Building Permit Application Package, a self-addressed stamped envelope, and a check for Two Hundred Fifty Dollars ($250.00), the submission fee for the aforementioned property. Your assistance is greatly appreciated. If you have any questions please call Stephanie Neher at 215-716-3539. Suffolk County License # 27587 THD At -Home Services, Inc. 40 Oser Avenue, Suite 17 Hauppauge, NY 11788 877.808.0050 75-2698460 (Federal Id Number) /Cord*y, Rosalee Burges cc: Stephanie Neher From: Sandra Beryt Fax: (888) 445-5945 To: +16317659502 IS MONEY" February 7, 2015 Fax: +16317659502 Page 1 of 1 0210712015 6:11 PM To: Town of Southold - Building Department Go Permits, LLC 12 Saner Road Marlborough, Ct 06447 Phone: 860-952-4112 Scoff Doughman Phone: 815-579-4567 Fax: 860-467-6614 scottdoughman@yahoo.com "WE UNDERSTAND YOUR TIME I am writing to request an extension for permit # 38236 for the installation of windows at 1000 North Rd in Greenport. The owner's last name is Lanfray. If you have any questions please call me at the number listed below. Thank you! ow d f 2--(P-15 Sandy Beryt, Permit Expediter rlK-- t') Q-Xp)r-a-+ 1 On J a'U J5 5 Go Permits, LLC Phone: 708-606-5903 Fax: 888-445-5945 sandroberyt@amail.com 12 Saner Road Marlborough, Ct 06447 Phone: (860) 952-4112 Fax: (860) 467-6614 He Edt 4§ 11 DocuMerk Tools WM(rm Help S �,W -------- — — — 119 �qltb �hepaqp XCU ment 6500 and 6100 PERFORMANCE COMPARISON Alindow Types U.S. Gow i Energy Star U -Factor Gas Fill �TypeofLowES&ft�oatll Totai I V- � R vjiu�e f U'l i Isibie Solar Heatf interior I Relative - Tota2 Light Ternperatupe 'a R av s H-Midili Window windo, a1 Bi- Trans- at 1, outsicil,_ Conden&ajrj,n mittance 701lnside poiw �o 0 ass "o i. No, e 9 -7 16-51 ,_.v -'h 6 w i t, ass No 6 1 CO ,;,'tar,t E"A 'mc n ie& —,on Zf :�aFC:, 1-j -'7: c, at 61 s 0H, e= Card ni! 27r-, E 91 F 62% C+ Eal Yes Z,--�ort oat Lc-sv Z 10 :S,4 F 6<1'r Ere es �ont of Ca-dln a! 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