HomeMy WebLinkAbout28188-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26517 Date: 06/13/02
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property: 2035 TOWN HARBOR LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 66 Block 1 Lot 30
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 19, 2002 pursuant to which
Building Permit No. 28188-Z dated MARCH 19, 2002
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 ADDITIONS AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to HERBERT J ADLER JR
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1051642 05/09/02
PLUMBERS CERTIFICATION DATED 04/09/02 MIKE JACOBY
1
r
utho ized sfignature
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 28188 Z Date MARCH 19, 2002
Permission is hereby granted to:
HERBERT J JR ADLER
PO BOX 308
SOUTHOLD,NY 11971
for
ADDITIONS AND ALTERATIONS TO A SINGLE FAMILY DWELLING AS APPLIED
FOR. THIS PERMIT REPLACES BUILDING PERMIT 424497
at premises located at 2035 TOWN HARBOR LA SOUTHOLD
County Tax Map No. 473889 Section 066 Block 0001 Lot No. 030
pursuant to application dated MARCH 19, 2002 and approved by the
Building Inspector.
Fee $ 150 . 00
42 `� 4 -
Authorized Signature
ORIGINAL
Rev. 2/19/98
i
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD,N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NOVEMBER 19 97
24497 Z Date.............................................................. 19...........
Permission is hereby granted to:
JOHN N. BLAKELY(ADLER)
..........................................................................................
PO BOX 432
...........I...........................................................I..................
SOUTHOLD,NY 11971
..........................................................................................
CONSTRUCT AN ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
to ..............................................................................................................................................................
AND ALTER THE SAME AS APPLIED FOR
..................................................................................................................................................................
..................................................................................................................................................................
......................................................................................................................................I...........................
..................................................................................................................................................................
50 TOWN HARBOR TERRACE SOUTHOLD
atpremises located at...............................................................................................................................
........................I................................................................I..................................I...........................
473889 066 0001030
County Tax Map No. .......................... Section ........................ Block ........................ Lot No. ........................
pursuant to application dated ...00TOBER 8 19 97 and approved by the
Building Inspector.
75.00
Fee $. .......................
....
.. .. spe
ilding Inspector
Rev. 6/30/80
Form No.6
TOWN OF SOUTHOLD
2 �2
S ,'..J 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 a 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$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00,
Swimming pool$25.00,Accessory building$25.00, Additions to accessory building$25.00,Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Photocopy of Certificate of Occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00
Date.
New Construction: Old or Pre-existing Building: Ll (check one)
Location of Property: a 0
House No. Street Hamlet
Owner or Owners of Property: We A (e r
Suffolk County Tax Map No 1000, Section 7 1p(p Block p 0b0 Lot p
Subdivision Filed Map. Lot:
Permit No. Z g R - J
Date of Permit. t Applicant: �" AA6— P
Health Dept,Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ✓� (check one)
Fee Submitted: $
I C_ I q Appli a ignatur
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5 BY THIS CERTIFICATE OF COMPLIANCE THE S
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
C5 BUREAU OF ELECTRICITY e5
40 FULTON STREET — NEW YORK, NY 10038
5 CERTIFIES THAT
5 Upon the application of upon premises owned by 5
r5 5
ROSLAK ELECTRIC HERBERT J ADLER JR.
5 P.O. BOX 164 2035 TOWN HARBOR LANE 5
5 CUTCHOGUE, NY 11935-2453, SOUTHOLD, NY 11971 5
5 Located at 2035 TOWN HARBOR LANE SOUTHOLD, NY 11971 5
5 5
CS Application Number: 1051642 Certificate Number: 1051642 5
c7 Section: Block: Lot: Building Permit:28188 Z BDC: NS11 5
Described as a Residential occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: 5
5 First Floor,Outside,
55
5 was inspected in accordance with the National Electrical Code and the detail of the installation, asset forth below,was 5
5 found to be in compliance therewith on the 9th Day of May, 2002. S
5 Name QTY Rate Rating Circuit Type 5
5 5
5 No visual defects: an elctrical survey has been made of the exposed electrical equpment in the premises indicated. No obvious unsatisfactory 5
5 condition was found. 5
5 Defects previously reported,as items of non-compliance,have been corrected. A visual inspection made of the exposed electrical equipment in 5
5 the premises indicated found no obvious unsatisfactory condition. 5
5 5
5 5
5 5
5 5
55 seal
5 1 of 1
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5
D �Prr�PrJ�P�P�PrJ��n�P�P�P�Pcli!n1P�P�P�PrJ�rilic-i n�n�n�P�P�P�n�P�P�PrJ�rJ�rn�P�P�PrJ��P�P�P�PrJ�n�P�P�P�PEP�P�P�P�P�n�P�P�P�P�P�Prn C
O rJ�cn�nrJ�rJ�r��lI PrJ�cPcnrSrJ�rJ�rJ�iJrJ�rJ�rJ�rJrJ@n�P�Pr1rJ�rJrJ�rJ��l�ncn�nrJ�rJ�rJ�rJ�CJ�CJ�Inr o
5 BY THIS CERTIFICATE OF COMPLIANCE THE 51
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
SBUREAU OF ELECTRICITY S
Cj 40 FULTON STREET — NEW YORK, NY 10038 5
5 CERTIFIES THAT 5
5 5
5 Upon the application of upon premises owned by 5
5 5 ROSLAK ELECTRIC 5 CT C HERBERT J. ADLER JR.
5 P.O. BOX 164 2035 TOWN HARBOR LANE
CUTCHOGUE, NY 11935-2453, SOUTHOLD, NY 11971
CCCC5 55�
Located at 2035 TOWN HARBOR LANE SOUTHOLD, NY 11971 Cmc
Application Number: 1051668 Certificate Number: 1051668 5
5 5
..7C7C7C5 Section: Block: Lot: Building Permit: BDC: NS11
Described as a Residential occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: C�
5 Basement,First Floor,Outside, 5
5 5
5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was 5
5 found to be in compliance therewith on the 9th Day of May,2002. 5
5 Name 2 Rate Rating Circuit Type
5 Alarm and Emergency Equipment S
5 Sensor 1 Carbon Monoxide 5
5 Sensor 5 Smoke 5
5 Wiring and Devices 5
5 Outlet 1 Fixture
5 rj Fixture 1 Incandescent C
Receptacle 1 GFCI C
5rs
5
5
SR
c
5 c
5
5
5
PR
5 VE
seal C
5
5
ED!
5 1 of 1 C
12PL
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. C
5 c
orPLI[I 150
t
• TSE NEW YORK BOARD OF FIRE UNDERWRITERS
Electrical wiring yin tis binding has
been inspected and fmindto comply
w ti, the eject�rI4,9 0 sofar as
"no RESI(►ENCE 0 s �E
LOCAT10Nz
REMARKS:
NOTE:—Above apProvallsugta� 00ftwly.
C
RA_ »
FUMiA Q6K WU
ToWn Hall,53095 Main Fload PaX(6 16)765-1823
P. 0. Box 1179 Talophonb(5 116)765-1602
Southold, NeW York 11971 .
�0%,�
l6rmaE OF THE bUILbING INSMOTOA
TOWN OP SOUTHOW
C E R T I F I C A T I O N
DATE17
Building Permit No, v2
owner: H!� /- J . J" 4d /,e k- J r
(please print)
Plumber: ,.K
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead:
t
(Plumbers nature)
sworn to befote me this
day ofh
Notary
P blick County
HELNE Notary Public,State off Neew York
No,4951364
Qualified in Suffolk County
^r n =cion rnir - AApy 22_, �() ��
GEORGE B. MICHOS, P.E.
CONSULTING ENGINEER 101 Longfellow Lane
Port Jefferson, NY 11777
(516) 928-8237
December 17, 1997
John Blakely
PO Box 432
Southold, New York 11971
Re: Adler Residence, 2035 Town Harbor La. , Southold
Dear Mr. Blakely:
I have reviewed the foundation plans for the above noted project
and find that an 8 inch masonry block wall is satisfactory and an
acceptable alternate to the poured concrete wall shown on the
plans .
If there are any questions please do not hesitate to call me.
Very truly yo
GM:ep G�yge > Michos, P.E.
cc : CES
GBM File 97E06
�P�� OF NEW YO
0 OµGE 1W/L'y
* ` °m
056%OFD �aC4
�OFESSIO�P�
O
7 l �l
765-1802
BUILDING DEPT.
INSPECTION
[ ] OUNDATION IST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ j INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE / / INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] F NDATION 2ND [ ) INSULATION
FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
6X REMARKS.
� 1.2
DATE INSPECTO
_I
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ " GH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY ,r
REMARKS:
DATE 7 3 INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ) FOUNDATION 2ND [ INS TION
[ ] FRAMING 14FINAL
[ ] FIREPLA C MNEY
REMARKS:
ldl
DATE �2--�INSPECTOR
f 1+:1.11 I Il;il'I:G I Illll 1t 1;1'I11C1�' Ili- t' _ l•Ulllll-II '!'
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BOARD OF HEALTH . . . : . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS
TOWN OF S0U'T11O1.D SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN iIALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY:
// Q( CALL . . .co gTf?igo2.745 4.939
.Examined 19Y 19•L••l� �( 7 MAIi. TO: . . . . . . . . . . . . . . . . . . . .
Approved...�/.�./L,q.•, 19.j.7 PenaiL No. 1. 1. .. ...................................
Disapproved a/c /.... .......... ..................................
...................................................... ,A/
(Ikhildim , nx c or)
APPLICATION FO BUILDING PERMIT
Date. . . . . . . . . . . . . . . . . 19. . . .
INSTRUCTIONS
a. •this application mist be completely filled in by typewriter or in ink and solmitted to the lknilding TugPector w
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan slowing location of lot and of buildings on premises, relationship to adjoining premises or public
streets or areas, and giving a detailed description of layout of prgperty mist be drawn on the diagram which is part of
this application.
c. •the work covered by this appiication Piny not be commenced before issuance of Building Permit.
d, UIxxi approval,of this application, the Building inspector will issue a Building Permit to the applicant. Such
I
ermit shall be,kept on the premises available for inspection Chrougliout the work.
e. No building shall be occupied or used in wtole or in part for any purpose whatever until a Certificate of.
Occupancy sihall have been granted by the Building Inspector.
APPLICKn N IS HEMBY M&DE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zane Ordinance of the 71own of Southold, Suffolk County, New York, and other applicable Iaws, Ordinances or
Regulations, for the ccxhstruction of buildings, acklitions or alterations, or for removal or demolition, as herein
described. Tne applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and
regulations, and to adult authorized inspectors oxh premises anxl in building for necessary inspections.
.....................................................
(Signature of applicant, or name, if a corioration)
, ,�0 Qf�GHARD RD,.. OUTHOI,D
...............
(Mailing, address of applicant)
State whether applicant is owner, leasee, agent, architect, engineer, general contractor, electrician, plumber or doilde
Name of roamer of premises ........3f.. -J RD�@12 JrZ • ..........................................
(as on the talc roll ,or latest deed)
If applicant is a corporation, signature of duly,auttmorized officer.
......................................... ............,.r..
}
(Nam: amxl title of wrlwrate officer)
Builders License No. ..�51���.!?�..........
Pihnbers License No. ..........................
Electricians License Na. .....................
Other Trade's License No. ....................
I. [ixcaLioo of ]ani on wlhich proposed work will be ckxme..............................................................
s(�
2035' .iO "N HARf3ak .ANG sourNotio NV. //99
.. ..........................................................................................................
Iluue:e Nnber Street HHamletun
County Tax Map Na. 1000 Section ....5 6,........ Block .......1/........ Lot ...31r�f.........
Sedxlivision ...................................... Filed Map Nn. ................ int ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Eziisting use and occupancy ........ Al1E/ LIN ......................
b. Intended use and occupancy ..............TINEl-I.INC� .
......... ..................................................
3. NcWue of work (dmecc whidh applicable): New Ikrilding ,,,,,,•••• Addition l'
Repair ........ Alteration ..........
.... Removal ............. Derolition ............ Other Work ...........
(1)escri pt ion)
4- IisLiukntec) Cost .. ?X ..... fee
. ...........................................
(to be paid on filing this application)
5 If cArellinmg, rxniher of dwelling tants ..... ..... NnLer of tkoe-fling rants on each floor ......
If garage, nnber of cars ...............
6- If lxuailmess, Commercial or mixed occupancy, specify nature and extent of eadn type of use.......................
7. Dinmensiams of .
existcing structures, if any: FronL..--!P ... Depth ...6 Rear ..f /,i1� h
'
........ .
...
Ik:iglmC -._-.....d.............. Nxmiher of Stories ........
ofms re structure with alterat cxn� or nklitions: Front t,k ,
Depth .._ .......... �t �....... Ileac .-.33.....-._
lleigJit .-.....V_......... Nnber of Stories t
g- Dinensiahs of entire new construction: int'ont .......... ... Rear .......,
1 .33.'. Ile,htlh ... a
.....AP t 8._••_••_
Ileiglhl
••-•• ••••h••••-...... N,fdher of Stories ...... /
9 Sizeof Former Owner ....P
of lot: Front .....$3 k 0........ `
' Rear ........ ........... Depth f lt!!
..... Na4QR
IO.i Dace of Arrdtaee me 0?'�OTr4 P, 1j
Ez
AI 7txme or use district in %Addn pranises are situated ............../Z
.........................................
12. lies proposed construction viblare ally Zoning law, ordinance or regulation: ......No
...........:..
13. Will lot be regraded ........N:$„......... Will excess fill be removed fronh premises: YES
NO
14. Nares of Owner of prtmises -."094T•J•--AQlkR? w R Address 2R3S flare No. 6 {6�
Nme of Architect: C S .. Address .•6?P Al �{..JA1(85h0Qr - .
_
flhohe No. ...k�1E 3C
lLnme of Contractor ..J 1i 1v N: A 6K'6kY........... Acklress .r�,�Q ORCHgQD RD,�'QUfif fl, No. �$1F�ppG
mT.4
15. Is this property within 300 feet of a tidal wetland? * YES .......... Ncl f�1Q
i
*1F YGS SOunilln 7011N 1IWnTS PERMIT MAY fig RL(fIIRlf.
PI.OT DIAGRAM
locate clearly anu all buildings, whether existing or proposed, and irxlicate all set-back dimensions
from property linesum
: Gi�� k riher or description according to deed, and show street canes and indicate
whether interior or con
135,
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O(AINIY (11 ..-...SS,,.
aOFiN-IJ..��RK �')�••, ....Iming, duly s�xurn, deposes shill says that Ire is the appl.icanC
.................
(Nannie of Individual signing contract)
slxwe n><mnmed,
Ile is the ....................°............CONT•2ACTOIL
............................................................
(k .. ....... ....nnrractor, agent, cor,xhnhte officer, etc.) I . ...
of said owner or owners, still is duly authorized to perforin or have performed the said work arxl to make and file this
appl icatiom; that all statements contained in Ibis app]icatioh are true to the IheHt of his know ed and
that: tile work will lie performed in time nchunner set forth in the application filed Clherewith. ge belief; anxl
')worn to before me Ilnis
E.4!._......day of
Notary Public '. 44:g:•� a,4�y�
...................
LINDA.).COOPER (Signature of Applicant)
N- tarn Public,Slate at Now York
lvch.4822563,Suffolk Cou '
Yarm EApires December 31,1nty>�
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