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40933-Z
���SUEFQ(p%QG� Town of Southold 3/30/2017 0 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38874 Date: 3/23/2017 THIS CERTIFIES that the building RESIDENTIAL ALTERATION Location of Property: 610 Richmond Rd, Southold SCTM#: 473889 Sec/Block/Lot: 51.-6-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/15/2016 pursuant to which Building Permit No. 40933 dated 8/24/2016 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: ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Richter,Dagmar of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40933 03-07-2017 PLUMBERS CERTIFICATION DATED 12-13-2016 chogue Plumbing ut o ' ed Signature -QgUFFBI TOWN OF SOUTHOLD BUILDING DEPARTMENT y a TOWN CLERK'S OFFICE o . SOUTHOLD, NY y�pl � �aoR 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#: 40933 Date: 8/24/2016 Permission is hereby granted to: Richter, Dagmar 101 Lafayette Ave Apt 17M Brooklyn, NY 11217 To: construct alteratons to an existing dwelling as applied for. At premises located at: 610 Richmond Rd, Southold SCTM # 473889 Sec/Block/Lot# 51.-6-11 Pursuant to application dated 8/15/2016 and approved by the Building Inspector. To expire on 2/23/2018. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $220.00 CO -ALTERATION TO DWELLING $50.00 LInspector $270.00 Bu 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. A vl.� ! U�l� New Construction: Old or Pre-existing Building: (check one) Location of Property: �Q �iG�l�1 a.�1 l -5C)U 77-�01� House No. j Street Hamlet Owner or Owners of Property: 1� U(A rf Mj� Suffolk County Tax Map No 1000, Section �j Block Lot 1 Subdivision Filed Map. Lot: Pen-nit No. 53 Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ � GV Applicant Signature pF SO!/��,®l 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 CA roger.richert(, -town.southold.ny.us Southold,NY 11971-0959 loouffm BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Richter Address:610 Richmond Road City:Southold St: New York Zip: 11971 Building Permit#: 40933 Section: 51 Block: 6 Lot: 11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: REP Electric License No: 46288-ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor 1st Floor Pool New Renovation X 2nd Floor X Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceding Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures 2 CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency FixtureTime Clocks Disconnect Switches 2 Twist Lock Exit Fixtures 0 TVSS Other Equipment. 1- Exhaust Fan, 1- GFI Protected Circuit for Radiant Floor Heat (GFCI -Circuit Breaker) Notes: Inspector Signature: Date: March 7, 2017 0-Cert Electrical Compliance FormAs typF SO�T�fo�� Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Southold,NY 11971-0959O��C�1UNrI,�� � o C�C�dC� D BUILDING DErART1VIENT DEC 1 3 2016 TOWN OF SOUTHOLD BUILDING DEPT. TOWN OF SOUTHOLD CERTIFICATION Date: Building Permit No. Owner: (Please print) / Plumber: (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this 3 day of L�, 201(0 0'&ne� 6UA� Notary Public, County CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Commission Expires April 14,2D-v � OF oUTy��o uu v,�``�' TOWN OF SOUTHOLD BUILDING DEPT. 765-18®2 INSPECT ON [ ] FOUNDATION 1ST [ ROUGH PLEIG. [ ] FOUNDATION 2ND [ SULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRIC L (FINAL) REMARKS: 6U UW► � 0 Q toesel cry C"V, m pmt 4 . DATE Ild INSPECTOR SOpTyo cOUMY,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1502 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLRG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: L)J4,, ✓ - cea DATE INSPECTOR FIELD INSPECTION REPORT TDATE COMMENTS b FOUNDATION(1ST) t.�I�U ------------------------------------ C FOUNDATION (2ND) l�7 z (o ( l ovq& vtvwtbl" D �® ROUGH FRAMING& y I PLUMBING ` 11 I LU dpi o h� ® ��G c ufw l r� INSULATION PER N.Y. �' y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS 0 .c-o �'�1D.� 14 m--c 1 _ Ff(e cAw✓ '40l{ ce,c-�l oc z b �a 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 6_ 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: Approved 20 1 Mail to- Disapproved a/c Phone: r Expiration ,20 (Jgoam0S 301sA�O.L •,,,(,v Iurml, Building Inspector 9w c t 50V APPLICATION FOR BUILDING PERMIT QefflAm5m f� , �Q 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 EH>ssee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (OD F—`C'A H OA© ED 3Oo l' AoI,_,�> (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. 1. Location of land on whichMA osed work will be done: Ci 1 D eo car t� yY>xT - f°A' House Number Street '� :���na�.f.�3,.� �:.;« hamlet 1 V. `1r ,)!,iCi;�i 1101"U0 County Tax Map No. 1000 Section ,, _.. ... , ,�Bloc� s,,., ,�t;, , �w� 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 �-�t p4aIS' b. Intended use and occupancy �'� i 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 5AT-4 kAJ (Description) 4. Estimated Cost 6'rj &96, D 0 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 mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front :;; Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear F-1 .i ., Depth 4 v` I Height Number of Stories 9. Size of lot: Front Rear Depth k_ w, -_ ?f , ,y, u5 j jy 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 f�PAIO14.Names of Owner of remise dress A(P1Done No. Name of Architect Address W MN9614 M Phone No /,55t W "7 J 22 Name of Contractor AddressefTlZ'� 0 64�-.,NY 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. STATE OF NEW YORK) SS: COUNTY OF 5 vWVL� 060 C7(1 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the gqg� b( L— (Contractd,'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 20JL, n IMELANIEi BROWIN Y� > Public,State of NewNa , No.01®ROW7 Notary PLiblic ClueiifledinSuffolk Coulnly gignature of Applicant Scott A. Russell SUPERVISOR N 2 �; a 1\vl[AN A(G1EN[1EN T C SOUTHOLDTOWN HALL-P.O.Box 1179 � 0 ,i� �� Town of Southold 53095 Main Road-SOUTHOLD,NEW YORK 11971 �G LIiL CHAPTER 236 - STORMWA.TER MANAGEMENT 'CORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) -- - -- -- -- -- - DOES THIS PROJECT INVOLVE ANY OF THE E E'OLLOWING: (CHECK ALL THAT APPLY) Yes No ®dA- Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface- ` ❑F1 B_ Excavation or f illing involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑QC. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑[3/ Site preparation within 100 feet of wetlands, beach, bluff or coastal dE. erosion hazard area. E] Site preparation within the one-hundred-year floodplain as depicted ---- --; -eri-�E��►�=�ap�=off- ion of new or resurfaced impervious surfaces of 1,000 square ®�. Installat 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 Ow I DeigIn Profesional-Agent ontractor,Other) e/ction District pEi_ g 11 C NAME D Block Lot ROR BALD,\t, JL'P:_RTNii;`1T USE ONLY i Contact Inform3ronc/ �v 7arvM1m •.,.,.ne. Reviewed By: - - - - - - - - - - - - — - - - - — Date. � � d1f, Property Address / Location of Construction Work= fff — — — — — — — — — — — —` ) Approved for processing Building Permit �i�lb�l� % _ — Stormwater Management Control Plan Not Required. S� I j Stormwater Management Coi7troi Plan ;s Required. u (Forward to Engineering Department for Review) FORM SMCP -TOS MAY 2014 i - ��OF SO�ryo Town Hall Annex Telephone(631)765-1802 54375 Main Road coo (631)765.9 2 P.O.Box 1179 G Q rogenrichertf fown.southoQtl nV us Southold,NY 11971-0959 �� I BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: I f ( Date: Company Name: 1Z 7— Name: License No.: Address: ® Phone No.: 6 �37 7 Cc, > ®-3 ' JOBSITE INFORMATION: (*Indicates required information) *Name: '2 G �4 A—e,(e-- 3 *Address: o av 1 Cross Street: *Phone No.: ro3 / 7 3_ C/ _ __— Permit No.: -3 - Tax-Map District: 1006 Section: Block: Lot: *BRIEF DESCRIPTION 0,OF WOR (Please Print Clearly) _ � -7 /��q� � i ""L" _ �'cel i (Please Circle All That Apply) *Is job ready for inspection: YES/ NO Rough In Final *Do you need a Temp Certificate: YES/ NO Temp Information(if needed) *Service Size: 1 Phase Whase 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 I - � o 82-Request for Inspection FormAo�Y��')�* ���� • N ON OVFD AS N TED DATE. _Y�.P. a U FE __ PY.. j a.�_. } %0 f lOT =Y BUILDING Dr. :7ENT AT L +- ch ch + 765-1802 8 AM TO 4 PM FOR THE c � � ( FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED { FOR POURED CONCRETE w tj f 2. ROUGH - FRAMING & PLUP iBING 0 o0i { 3. INSULATION 4. FINAL - CONSTRUCTION MUST v �' rn � BE COMPLETE FOR C.O. o ALL CONSTRUCTION SHALL MEET THE Lo L s REQUIREMENTS OF THE CODES OF NEW I YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. L N C07-171 Y ?'!I!TH >F-,LL CODES OF ��) •ffAA Z W `i NEW`�':fr ; STATE E & TOWN CODES o4S REG�J{FiED $!�I� �n�'�,i gun � RD .it! . ...,....�._,_�.. I•!.Y.$.Dom_ G^- G V1 i �� V t ` { :4\�:�� � Y ..i�" ;"mss,' '� —'� f s �xt,��:"�;�-'��-=�� • O� OCCUPANCY OR N � I USE IS UNLAWFUL / J ` �Vy WITHOUT CERTIFICATE OF OCCUPANCYCL t Ale PLUMBER CERTIFICATION ON LEAD.CONTENT6EFt�RE . .. _ - - -. _ 1 CERTIFICATE&-6000_JPOCY SOLDER USED IN WATER SUP•PLY-SYSTEM A�NNO EXCEED 2110 OF 1%�.EA�! _ A I rr - — - ----- _ __-- - -T- PLUMBING ALL PLUMBING WASTE -I &WATER LINES NEED - ------ TESTING . BEFORE COVERING .'��� � . I TEST(P�G B �n x ro • ��D 684 I I""H IAC"Imo- 7 2 5—1 e.47 �W Q V�,A Te-- . j I ._ j