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Home My WebLink About37085-ZTown of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37643 Date: THIS CERTIFIES that the building ALTERATION Location of Property: 35 Clark Rd, Southold SCTM #:. 473889 Sec/Block/Lot: 51.-3-26 7/6/2015 7/6/2015 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/23/2012 pursuant to which Building Permit No. 37085 dated 3/23/2012 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: make minor alterations to an existing dwelling as applied for The certificate is issued to Matthew Gross of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 37085 5/24/2012 6/26/2015 Pace Analytical Auto ,red gnatur �UFFoa,r TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o . 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 #: 37085 Date: 3/23/2012 Permission is hereby granted to: Magno, Marie 2 Bills PI Brooklyn, NY 11218 To: make minor alterations to an existing dwelling as applied for At premises located at: 35 Clark Rd SCTM # 473889 Sec/Block/Lot # 51.-3-26 Pursuant to application dated To expire on Fees 9/22/2013. 3/23/2012 and approved by the Building Inspector. 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: 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. S. 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 J. 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. t New Construction: '� Old or Pre-existing Building: (check one) Location of Property: House No. Street Hamlet Owner or Owners of Property: IAJU-e 'ipV,,°rn p Suffolk County Tax Map No 1000, Section j I Block Lot oZfo Subdivision Filed Map. Lot: Pen -nit No. 53 s Date of Permit. 3 - �i —�r� . Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 00 Applicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Telephone (631) 765-1802 Fax(631)765-9502 roger. riche rKED-town. so Litho Id. ny.us CERTIFICATE OF ELECTRICIAL COMPLIANCE 'SITE LOCATION Issued To: Matthew Gross Address: 35 Clarks Rd City: Southold St: NY Zip: 11971 Building Permit#: 37085 Section: 51 Block: 3 Lot: 26 WAS EXAMINED AND FOUND TorBE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: G&S Electric License No: 578-e Residential Commerical New Addition Service 1 ph Service 3 ph Main Panel Sub Panel Transformer Disconnect Other Equipment: Notes: X Indoor Outdoor Renovation Survey SITE DETAILS Office Use Only X Basement X 1st Floor X 2nd Floor Attic Service Only X Pool Hot Tub Garage Inspector Signature: Date: May 24 2012 81 -Cert Electrical Compliance Form.xls INVENTORY Heat Duplec Recpt 5 Ceiling Fixtures HID Fixtures Hot Water GFCI Recpt 2 Wall Fixtures Smoke Detectors A/C Condenser Single Recpt Recessed Fixtures 9 CO -Detectors A/C Blower Range Recpt . Fluorescent Fixture Pumps Appliances dw Dryer Recpt Emergency Fixtures Time Clocks Switches 1 Twist Lock Exit Fixtures TVSS Inspector Signature: Date: May 24 2012 81 -Cert Electrical Compliance Form.xls SOpr�,o� @��'YCa►►uN 0�� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION IST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING/STRAPPING [ ]FINAL [ ]FIREPLACE 8 CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL) REMARKS: DATE � I� INSPECTOR' cou TOWN. OF SOUTHOLD BUILDING DEPT. 765-1502 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND[ ] IN TION [ FRAMING /STRAPPING [ FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUEN) [ ]ELECTRICAL (FINAL) REMARKS: L ZN INSPECTOR OF SOof UTyolo ' G Q C� OWN OF SOUTHOLD BUILDING: DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] FOUNDATION 2ND [ ] FRAMING/ STRAPPING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [,QlELECTRICAL (FINAL) REMARKS: �- eve --- DATE INSPECTOR � 76 ��OF SOUryO �o TOWN OF SOUTHOLD BUILDING DEPT. 765-1602 INSPECTIO [ ] FOUNDATION IST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE A CHIMNEY [ I ROUG PLBG. [ ] 1 CATION [ FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION DATE INSPECTOR D. MIN D D Sn.t VoiMpAltioN (IST). .Mw ,MqrTYwYrw�.Y,Y FOUNDATION (2N))) ROUGE PLU-MING INSUL. ATION mil. N. Y. STATE RNMGY COIF' F.Ma Analytical Method: SW601OC : Prep Method: SW3050B Prep Date: 6/25/2015 8:10:00 AM Analyst: JA Parameters) Results Qualifier D. F. Units Limit Analyzed: Container: Lead < 0.10 D 10 % 0.2 06/26/2015 3:12 PM Container -01 of 01 �0 JUL L - L 2011 Qualifiers: E =Value above quantitation range, Value estimated. B =Found in Blank D.F. = Dilution Factor D = Results for Dilution - Ar I H = Received/analyzed outside of analytical holding time Sample Information: + = NYSDOH ELAP does not offer certification for this analyte / matrix / method c = Calibration acceptability criteria exceeded for this analyte Type: Solder r aLcXe.AnalAcal LABORATORY RESULTS Origin: Distribution t — Results for the samples and analytes requested Routine 575 Broad Hollow Road, Melville, NY 11747 without the written approval of the laboratory. Result(s) reported meet(s) NYS Regulatory Limit(s). TEL: (631) 694-3040 FAX: (631) 420-8436 i The lab is not directly responsible for the integrity of the sample before receipt at the lab and is responsible only for the certified tests requested. i NYSDOH ID#10478 www.oacelabs com Paee 1 of 3 HARRY GOLDMAN WATER TESTING Lab No. : 1506G42-001 8700 MAIN ROAD MATTITUCK, NY 11952 Client Sample ID.: MATT GROSS Attn To 35 CLARK ROAD, SOUTHOLD, Federal ID SOURCE: UNDER KIT SINK (COLD Collected 06/19/2015 10:40 AM Point No WATER PIPE) Received 06/19/2015 3:05 PM Location: Collected By: AF99 Analytical Method: SW601OC : Prep Method: SW3050B Prep Date: 6/25/2015 8:10:00 AM Analyst: JA Parameters) Results Qualifier D. F. Units Limit Analyzed: Container: Lead < 0.10 D 10 % 0.2 06/26/2015 3:12 PM Container -01 of 01 �0 JUL L - L 2011 Qualifiers: E =Value above quantitation range, Value estimated. B =Found in Blank D.F. = Dilution Factor D = Results for Dilution - H = Received/analyzed outside of analytical holding time Sr.Project Manager + = NYSDOH ELAP does not offer certification for this analyte / matrix / method c = Calibration acceptability criteria exceeded for this analyte R = Reporting limit below calibration range. Value estimated. Test results meet the requirements of NELAC J = Estimated value - below calibration range unless otherwise noted. S = Recovery exceeded control limits for this analyte This report shall not be reproduced except in full, N = Indicates presumptive evidence of compound without the written approval of the laboratory. Result(s) reported meet(s) NYS Regulatory Limit(s). Result(s) flagged with * Exceed NYS Regulatory Limit(s). Limit noted. r)afa Ranortari - R/9612015 Paee 1 of 3 PACE ANALYTICAL 575 Broad Holloiv Road ..s aceAnaEytical~ Melville, NY 11747 Sample Receipt Checklist TEL: (631) 694-3040 FAX. (631) 420-8436 Website: timmoacelabs.com Client Name HGO Date and Time Received: 6/19/2015 3:05:00 PM Work Order Number: 15061342 RcptNo: 1 Completed by: Completed Date: 6/19/2015 4:34:47 PM Carrier name: PACE Pickup Chain of custody present? Chain of custody signed when relinquished and received? Chain of custody agrees with sample labels? Are matrices correctly identified on Chain of custody? Is it clear what analyses were requested? Custody seals intact on sample bottles? Samples in proper container/bottle? Were correct preservatives used and noted? Preservative added to bottles: Sample Condition? Sufficient sample volume for indicated test? Were container labels complete (ID, Pres, Date)? All samples received within holding time? Was an attempt made to cool the samples? All samples received at a temp. of > 0° C to 6.0° C? Response when temperature is outside of range: Sample Temp. taken and recorded upon receipt? Water - Were bubbles absent in VOC vials? Water - Was there Chlorine Present? Water - pH acceptable upon receipt? Are Samples considered acceptable? Custody Seals present? Airbill or Sticker? Airbill No: Case Number: SDG: Received by Lloyd Olsen Reviewed by: -�S� Reviewed Date: 6/22/2015 10:55:39 AM Yes No ❑ Yes No ❑ Yes No ❑ Yes No ❑ Yes ❑d No ❑ Yes ❑ No ❑ Not Present W Yes W No ❑ Yes W No ❑ NA ❑ Intact 91 Broken ❑ Leaking ❑ Yes 0 No ❑ Yes 0 ' No ❑ Yes 0 No ❑ Yes V No ❑ NA ❑ Yes V No ❑ NA ❑ Yes No ❑ To 3.6 ° Yes ❑ No ❑ No Vials W], Yes ❑ No ❑ NA ❑�/ Yes 0 No ❑ No Water ❑ Yes ❑d No ❑ Yes ❑ No �/❑ Air Bii ❑ Sticker ❑ Not Present d❑ SAS: Any No response should be detailed in the comments section below, if applicable. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — - ---------------------------------- Client Contacted? ❑ Yes ❑ No d❑ NA Person Contacted: Contact Mode: ❑ Phone: ❑ Fax: ❑ Email: ❑ In Person: Client Instructions: Date Contacted: Contacted By: Regarding: Comments: CorrectiveAction: Page 2 of 3 _ 'cCe, Ana lylica 575 Broad Hollow Road, Melville, NY 11747 TEL (631) 694-3040 FAX: (631) 420-8436 NYSDOH ID#10478 www.oacelabs.com WorkOrder : 1506G42 Certifications STATE ICERTIFICATION# NE W YOR K 10478 NEWIERSEY NY158 CONNECTICUT P H-0435 MARYLAND 208 MAS S AC HUS E TTS MNY026 NEW HAMP S HIRE 2987 RHODE ISLAND LA000340 P E NNS YLVANIA 68-00350 Page 3 of 3 OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, .NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net PERMIT NO. 3 29, J Examined 20 % y' Approved 20 Disapproved a/c BUILDING PERMIT APPLICATION CHECKLIST •Building Inspector 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:(/ 2)1— 5)-1— S-5 S - CATION FOR BUILDING PERMIT INSTRUCTIONS Date , 20 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. (Signature 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 Name of owner of premises (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. 1) LCIXJe t CLO I'AI c7 W\C\_ t,0 0 r Electricians License No. Other Trade's License No. 1. Location of land on which prop S �� G House Number Street sed work will be done: I -Ir Ile/ Hamlet County Tax Map No. 1000 Section S/ Block Lot 2 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premise , nd intended use and occupancy ofproposed construction: a. Existing use and occupancy 1,e/ ll ��'� /�/� �/ %/U- Ile 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 E 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 Depth Dimensions of same structure with alterations or additions: Front Rear- Depth earDepth 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 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re -graded? YES NO v Will excess fill be removed from premises? YES_ 14. Names of Owner of premises /It# GrosS Address 3S C�r� �/. 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 * 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. r. NO 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, CONNIE D. BUNCH Notary Public, State of New York (S)He is the No. 01BU6185050 (Contractor, Agent, Corporate Officer, etc.) Qualffied in Suffolk County Commission Expires April 14, 2 0 ll 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 0; day of 1ADA CA 20�� Notary Public Signature of Applicant Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 f�j Telephone (631) 765-1802 ax (631) 71 -It -g516. roger richert town sou0ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: 03 Company Name: ry s &ecru L. Name: 20 g [ 6 oF%cZGZ-c L -C License No.: - Address: (? o . Q.0 x ')-d S' Sm v—%-ko c---4 IU-`. 1 Lq 71 Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: zt) a&P S S Cr r OJ *Address:3S' if L-AAt-S 'QA , S00-1 0L6� *Cross Street: /Or *Phone No.: Permit No.: Tax Map District: 1000 Section: 1 Block:_ Lot:_ *BRIEF DESCRIPTION OF WORK (Please Print Clearly) A-', 7- GJ1 E 4 �4^��yA% low! 1�j .4 01,> '&/ /Gl.Q T.i (Please Circle All That Apply) *Is job ready for inspection: YES NOough In Final *Do you need a Temp Certificate: YES NO 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 Form9 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 May 30, 2012 Matthew Gross 17 Purchase Hills Dr Purchase, NY 10577 BUILDING BUILDING DEPARTMENT TOWN OF SOUTHOLD Re: 35 Clark Rd., Southold TO WHOM IT MAY CONCERN: The Following Items Are'Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. (contact your electrician) A fee of $50.00. Final Health Department Approval. Telephone (631) 765-1802 Fax (631) 765-9502 v 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. BUILDING PERMIT: 37085 -Alterations Town Hall Annex _ 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 December 3, 2012 Matthew Gross 17 Purchase Hills Dr Purchase, NY 10577 pF SOUj�,� O01• COQ �ycOUNTY,� BUILDING DEPARTMENT TOWN OF SOUTHOLD Re: 35 Clark Rd, Southold TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. (contact your electrician) A fee of $50.00 Telephone (631) 765-1802 Fax (631) 765-9502 Final Health Department Approval. o�✓ 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. BUILDING PERMIT: 37085 -Alterations 37Vd8 IMVLO Ni ?:GaMI9 89XL� 37Vd9 IIINs1 NI 3�V rd --\ ELECTRICAL. NSPECTICN REQUIRED APPROVED AS N07r' DATE -4A49; B. 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