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39876-Z
c 0 CO2 Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37635 Date: THIS CERTIFIES that the building FIREPLACE Location of Property: 475 Wood Ln, Greenport SCTM #: 473889 Subdivision: Sec/Block/Lot: 43.-4-20 Filed Map No. 7/1/2015 7/1/2015 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/9/2015 pursuant to which Building Permit No. 39876 dated 6/17/2015 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" fireplace in an existing one family dwelling as applied for. The certificate is issued to Reinholt, Sonja & Derr, Andrew of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 4 Au t e ignat re Permit #: 39876 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) Permission is hereby granted to: Reinholt, Sonja & Derr, Andrew 475 Wood Ln Greenport. NY 11944 Date: 6/17/2015 To: Construct a fireplace in existing single-family dwelling as applied for. Additional certification may be required. At premises located at: 475 Wood Ln. Gree SCTM # 473889 Sec/Block/Lot # 43.4-20 Pursuant to application dated 6/9/2015 To expire on 12/16/2016. Fees: and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $200.00 CO - ALTERATION TO DWELLING $50.00 Total: $250.00 �Q ---" uilding 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 Dante. New Construction: Old or Pre-existing Building: (check one) Location of Property:% tj=-) �__ p.,�Q__. lTn-e�v� po House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section 5-3 Block Subdivision Filed Map. Permit No. ✓ 9 0 � Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Cjn 06 Lot � Z— Applicant:_ _ Underwriters Approval: Final Certificate: 1! Lot: (check one) Frank Wolfgang Uellendahl Architect 123 Central Ave POB 316 Greenport, NY 11944 t: 631.477.8624 e: frank@frankueliendahl.com June 2, 2015 Submitted to: Building Department Town of Southold Owners: Andrew Derr and Sonja Reinholt 475 Wood Lane, Greenport„ NY 11944 Re: Certificate of Occupancy for a wood burning fireplace LETTER OF GERTIF1CATfOW In the above referenced single family home a wood burning fireplace was installed by the previous owner without applying for a building permit. The current owners are in the process of selling their home and wish to apply for an As -Built Permit in order to obtain the certificate of occupancy. I visited. the residence today and inspected the fireplace. According to the owners the fireplace has been in operation without problems during the entire winter season. The metal flue has a 2" airspace to combustables in the attic, and the required firestop at ceiling penetration. I herewith certify to the best of my knowledge that the fireplace installation was performed per code. D G rsF SO(/j�olo , f Cpl • �Q _ �,J y � �! CpUM'r,0 TOWN OF SOUTHOLD BUILDING- DEPT.- ; 765-1802 l:NSPECTl0-N:-,__. [ ] FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING/ STRAPPING [ FINAL [ ] FIREPLACE A CHIMNEY. [ ] ' FIRE SAFETY' INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE-RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL -(FINAL) [ ] CODE VIOLATION [ ] CAULKING - REMARKS: O DATE rf INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BUILDING PERMIT APPLICATION CHECKLIST SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net PERMIT NO. Examined , 20 Approved 20 Disapproved a/c Expiration -1 i it 0 20 JUN (O'i''id N SOUT1101 n 1-5 Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Single & Separate Storm -Water Assessment Form Contact: Mail to: Phone: B kding I ector CATION FOR BUILDING PERMIT INSTRUCTIONS Date G - l - y- ,20 1 C 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, housin ode, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ! L 1 (Signature of applicant or name, if a co oration) 117.> Qoo, L Ac rd ..' �n�o r { ( l 4, (Mailing addres of applicant) State whethe applicant is owner, lessee, agent; architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises'' ` Sm tGL V (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. I on which proposed work will be done: d o r-,) L.� -Q -- House Number Street County Tax Map No. 1000 Section, Block ley - Hamlet 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 r, k A ( b. Intended use and occupancydJ5:L] ( IDL -1-26 A L 11 Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work oal4cce_— �— (Description) 4. Estimated Cost If dwelling, number of dwelling units If garage, number of cars Fee (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 of existing structures, if any: Front Height Number of Stories Rear Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Depth Rear 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 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 f6o ' Address 4 S LX� LU Phone No. Name of Architect 4 Rcud QW Address ; V LrU 69)UPhone No 4?,(,-_q_M 04 - Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * 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. CHRISTINA VOLINSKI STATE OF NEW YORK) NOTARY PUBLIC -STATE OF NEW YORK SS: No. 01V06105050 COUNTY OFLA Qualified in Suffolk County My Commisslon Expires February 28, 2016 01)12jz L:�--Lj fl being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the Dc� (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. SIIIIQ Scott A., Russell ���°� SUPERVISOR 0 SOUTHOLD TOWN HALL - P. O. Box 1179 m 53095 Main Road - SOUTHOLD, NEW YORK 11971 55TORIM[\WATJEIK IWA A— G lEMUENT Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) DOLES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: (CHECK ALL THAT APPLY) ❑ ff A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑EdB. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑ U C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑ EfD. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑[ E. Site preparation within the one -hundred -year floodplain as depicted ❑don FIRM Map of any watercourse. 1F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Ottheer) NAME: 'GW01?'0( K1+-4 A aj)\)eg Contact Information: C 9. Property Address / Location of Construction Work: .-47S- I-% r�- M (NO FORM 4 SMCP - TOS MAY 2014 S.C.T.M. #: 1000 nate: District Section qBKk -Lot "'FOR BUILDING T)E1'AR FN1LNT U. E 0N1-) •.`*:' Reviewed By: )f i Date: _n/ Approved for processing Building Permit. Stormwater Management Control Plan Not Required. ❑Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review.) /v/m - y,? — ;/ - -9 d TOWN OF SOUTHOP PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT ORMER OWNER 4, Lovg a -f TA k'1S A-44--, E ACR. A) �av e-�IS wx, s W TYPE OF BUILDING RES. SEAS VL. FARM COMM. CB`s MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS J� L 0, 0 o 6 0-,5-Zgl(l P ?VA; c - v- re- r v hfl- Laveoil- c M f r-1 17 - L z-, 5o 2'/ L 4v,&7" -a /-Z) Ae-fmho /f A?41� 66W(::71)�o , aa 6eo s6g 2 0,jnf!4,)Av-j, (240 -go AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE' FARM Acre Value Per Acre Value Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total DOCK X f�"��.' f t�}�� w�lN \y _,,,�4a CC,J• MUDROOM w mJ ADDITION o = TO THE w J Z W 1 - APPROVED AS NOT )ATE: / E.P. # 'EE: 260 -bb BY: IOTIFY BUILDING DEPARTME-1 65-1802 8 AM TO 4 PM F(Z OLLOWING INSPEC T IONS: FOUNDATION - TWO REQI.KI FOR POURED CONCRETE o ROUGH - FR,AM.ING & PLUIA INSULATION FINAL - CONSTRUCTION ki BE COMPLETE-. F^R C.O. LL CONSTRUCTION S} -TALL � EQUIREMENTS OF THE CODE YORK STATE. NOT RESPON54I STREET ELEVATION DESIGN OR CONSTRUCTIONX0 Z RETAIN STORM WATER Fig PURSUANT TO CHAPTER6 OF THE TOWN CODE. 9 RR i '! 1 i�L - PORT, NY 475 WOOD LANE ARCHITECT INGFRANK UELLENDAHL 123 CENTRAL AVENUE T P.O.BOX 316 GREENPORT, NY 11944 TEL: 631-477 8624 ET THE OF NEW OWNERS LE FORANDREW DERR IRM NJA REINHOLT 475 WOOD LANE IDWEENPORT, NY 11944 36 TEL: 917-301-7315 0 W 0 CON4P'LY WITH ALL COQ ES, QF NEW YORK STATE & TOV1 D AS REQUIREID AND CONDW S S2 S2 a 0 OCCUPANCY OR USE IS UNLAWFUL= WROUTG . TIA 01 OC C U d -�^i-; ,,. DATE: 06/02/2015 �Z SCALE: N.T.S. 0 E o FLOOR PLAN STREET ELEVATION DWG. NAME C A-4 ©¢ DWG. NO