HomeMy WebLinkAbout40900-Z So FOL
Town of Southold 10/17/2016
3 y P.O.Box 1179
a
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38590 Date: 10/17/2016
THIS CERTIFIES that the building HOT TUB
Location of Property: 410 Bunny Ln,New Suffolk
SCTM#: 473889 See/Block/Lot: 117.-6-28.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/5/2016 pursuant to which Building Permit No. 40900 dated 8/11/2016
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:
ACCESSORY HOT TUB AS APPLIED FOR
The certificate is issued to Hemer,Alec
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40900 10-04-2016
PLUMBERS CERTIFICATION DATED
A th ed Signature
�o�gisFFnt,r�oTOWN OF SOUTHOLD
aye BUILDING DEPARTMENT
a 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#: 40900 Date: 8/11/2016
Permission is hereby granted to:
Hutchinson, James
PO BOX 308
New Suffolk, NY 11956
To: install hot tub as applied for.
At premises located at:
410 Bunny Ln, New Suffolk
SCTM # 473889
Sec/Block/Lot# 117.-6-28.1
Pursuant to application dated 8/5/2016 and approved by the Building Inspector.
To expire on 2/10/2018.
Fees:
ACCESSORY $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Pi -,
Buil 'ng I ector
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 ofcompleted 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. g s
New Construction: Old or Pre-existing Building: (check one)
Location of Property: L4 1 O i; u NH y L"r J tj g-7w v tic t_yc,_ ty�y
House No. Street Hamlet
Owner or Owners of Property: 1)L> C- E L JS PV U RZ Prpf F,0
Suffolk County Tax Map No 1000, Section Block O /(--) Lot 2
Subdivision Filed Map. Lot:
( r
Permit No. `l 0 q 0 Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: '� (check one)
Fee Submitted: $ 50
Applicant Signature
pF SO(/P�,®l
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 , ® aQ roger.riche rt(aD-town.southoId.ny.us
Southold,NY 11971-0959 Q
lyC®UNTT1,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Hemer(Hutchinson)
Address: 410 Bunny Lane City: New Suffolk St: New York Zip: 11956
Building Permit#: 40900 Section 117 Block: 6 Lot: 28.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: MRJ Industries LTD License No: 41853-ME
- SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub X
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures 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 Fixtures Time Clocks
Disconnect Switches Twist Lock ri Exit Fixtures 11 TVSS
Other Equipment: Supply GFCI Protected Power to Disconnect for Self Contained Hot Tub.
Notes:
Inspector Signature: Date: October 4, 2016
0-81-Cert Electrical Compliance Form.xls
D�, � �aOF SOpl�o
�o
0 M`I,��Q
TOWN OF SOUTHOLD BUILDING DEPT.
765-1602
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: fi Is
1Y1 &v's .
4n,
C)
DATE A L �p INSPECTOR
OF SOUIyo�0/200 , uON
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
REMARKS:
DATE /a �� INSPECTOR
ti
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(IST) ® y
--------------------------------------
FOUNDATION
-----------------------------------FOUNDATION(2ND)
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ROUGH FRAMING&
PLUMBING y
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INSULATION PER N.Y.
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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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 ,20 Single&Separate
Storm-Water Assessment Form
Contact: h
Approved ,20W Mail to:
Disapproved a/c
Phone: I q
(_1 — wo s^ L/
Expiration 0 1-20
��o V r Bui g spector
AUG - 5 2016 OLICATION FOR BUILDING PERMIT
Date ��`T��- 5 , 20 1 (o
BUILDING DEPT, INSTRUCTIONS
TOWN OF SOUTHOLD
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
o W to-2,�-
Name of owner of premises ll eL H-e Pv^o'r a v`d ti t t se'
(As on the tax roll or latest deed)
If applicant is a corporation,'signature of duly authorized officer
(Name andt,title°of•irorporate,officer) .
Builders License'No•.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
410 e- N e,j.0 Ic
House Number Street Hamlet
County Tax Map No. 1000 Section Block 01D Lot c�-
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
b. Intended use and occupancy
3. Nature of work (check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work f-v In
(Description)
4. Estimated Cost 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 ixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structur s, if any: Front Rear Depth
Height \Number
s
Dimensions of same structure or additions: Front , '"" " `:;' a z i''"Rear
Depth Numbf$t`ori'e '''
8. Dimensions of entire new construRear . t Fv h Depth
Height ies
9. Size of lot: Front Depth }'``_
44 3.a':E tvSh P y�i VI ;, A.•
10. Date of Purchase Name of Form Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinan\removeg
on? YES NO
13. Will lot be re-graded? YES NO Will excess fill be m premises? YES NO
14. Names of Owner of premises AddressPhone 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? *Y NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUI D.
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.
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
�, NeIVL_-- Notary Public,state of New York
(S)He is the No.01BU6185050
(Contractor, Agent, Corporate Officer, etc.)
Commission Expires April 14,2
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 thi
day of 20�jo
Notary Public Signature of Applicant
Scott A. Russell l?�av ZD
SUPERVISOR 53 , t� 'I :t
SOUTHOLD TOWN HALL-P.O.Box 11794?
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
CHAPTER 236 - STORIY wA.TER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT Y
----------- - -------- - --- --- ---- - - -- -
DOES THIS IPROJIECT INVOLVE ANY ®� THE IF®I.I.®�1®1
(CHECK ALL THAT APPLY)
Yes No
E][aA_ Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface_
[:1["'B_ Excavation or f illing involving more than 200 cubic yards of material
within any parcel or any contiguous area.
E9-C_ Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑(� D. Site preparation within 100 feet of wetlands, beach, bluff or coastal ;
} erosion hazard area. .
❑aE. Site preparation within the one-hundred-year floodplain as depicted
IRdvW—p=e -any--wat-&-r-c
❑[W'-F. 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.
S.C_T.M. 1000 Date:
APPLICANT: (Property Owner,Design Professional.Agent,Contractor,Other) I District
NAME IT'LG� a�2— Section Block Lot
'r'vR Bi llL Ui G uL'P ART-N=1lr_-NT USE GN`,-
Contact Information
Reviewed By:
— — — — — — — — — — — — — — — — — — Dale: 3
Property Address / Location of Construction Work: — — — — — — — — —
Approved for processing Building Permit.
y[® N pj-,y '►�flz Stormwater Management Control Plan Not Required
- -
mis
j 1 Storwater ai:agen':eni Control Plan is Required_
Il (Forward to Engineering Department for Review.)
FORM = SMCP - TOS MAY 2014
i
S�r'�O
op
Town Hall Annex Telephone(631)7g6�5-1802
54375 Main Road e� ft (63 S7J QQ nV US
P.O.Box 1179 rr roaer.riche Wrl OI
Southold,NY 119714959
s
WELDING DEPARTMENT
TOWN OF SOtrMOLD
APPLICATION FOR ELECTRICAL INSPECTION
r ,
REQUESTED BY: �f \ f Date:
Company Name:
Name: d r . �� �-• '
License No.: 1118 57 - - l
Address: " i
Y:5
Phone No.: 5-16
JOBSITE INFORMATION: (*Indicates required information)
*Name: �le-c, e t-p?C2
*Address: /-)/0 ev/7 n )-e 7 e
*Cross Street
*Phone No.: 917 L10 8 d _ --
Permit No.: !gyp
Tax-Map District: 1000 Section: Block: Lot:.' 1 J
*BRIEF DESCRIPTION OF WORK(Please print Clearly)
h10 GLji
(Please Circle All That Apply)
*Is job ready for inspection: CES N Rough In Final
*Do-you need a Temp Certificate: YES/ O
Temp Information(If needed)
*Service Size: 00 160 350 400 Other
*New Service: D
UM
of Meters Change of Service Overhead
W&M
Additional lnf PAYMENT DUE WITH APPLICATION
EP - 7 2016 -
RUMDING DEPT.
TOWN O G
SMequest for InwWflon Form
C, �l
,-- SURVEY OF PROPERTY
FDDNo SI T UA TE
F_CONCMON
NEW SUFFOLK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
BO'S ROAD S.C. TAX No. 1000-117-06-28.1
SCALE 1 "=20'
SEPTEMBER 8, 1998
" JUNE 4, 2009 UPDATE SURVEY & ADDED PROPOSED GARAGE
AREA = 19,996 sq. ft.
0.459 ac
I �
I CERTIFIED TO:
JAMES HUTCHINSON
SUSAN HUTCHINSON
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COPIES OF THIS SURVEY MAP NOT BE
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CEfOIFlCARGNS INDICATED HEREON SW
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LENDING INSTRULISTED HEREON
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ANY,NOT SHOWN ARE NOT GUAR
FOUND PREPARED IN ACCORDANCE Wf1H THE MINIMUM r�'�p
CONC.YON STANDARDS FOR TIRE SURVEYS AS ESTABUP�SHDEF)•-_.. Nathan, 'aft C®r�+v
BY THE LIALS AND APPROVED AND 4AAI�`itl •�
FOR SUCH USE GY THE NEW YOR 1r AAA TITLE
ASSOCIAAON •SP/r�'�;(.�O Land S u r V e y®i
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Fox 631 72
PHONE {631)727-2090 � )
LANL)SVZ, / OFFICES LOCATED AT &WILING AC
322 Roanoke Avenue P 0 DDK
E N Y.S Llc No 50467 Riverhead, New York 11901 Riverhead, New Yor
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AAPPOD AS NO ED
DAT8,P,#FEE: BY, COMPLY WITH ALL CODES
NOTIFY BUILDING DEPART M T NEW YORK STATE & TOWN CODE
765-1802 8 AM TO 4 PM FOR THE AS REQUIRED AND CONDITIONS OF
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST N.MEC
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236
OCCUPANCY OR OF THE TOWN CODE.
USE IS UNLAWFUL
WITHOUT CERTIFICATE ELECTRICAL
OF OCCUPANCY INSPECTION REQUIRED
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