HomeMy WebLinkAbout41413-Z SUFFQ(k° Town of Southold
' o� • � • �oG, 4/27/2017
y P.O.Box 1179
a
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38920 Date: 4/27/2017
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 870 Village Ln, Mattituck
SCTM#: 473889 Sec/Block/Lot: 114.-6-16
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/1/2017 ' pursuant to which Building Permit No. 41413 dated 3/10/2017
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"partially finished basement with bathroom as applied for.
The certificate is issued to Horan,Peter&Patricia
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41413 4/14/2017
PLUMBERS CERTIFICATION DATED 4/20/2017 Rian Cucc
A th ed Signature
" TOWN OF SOUTHOLD
gUFFOt,�c�y '
BUILDING DEPARTMENT
c 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)
Permit#: 41413 Date: 3/10/2017
Permission is.,hereby granted to:
Horan, Peter & Patricia
870 Village Ln
Mattituck, NY 11952
To: legalize "as built" unfinished basement altered to living space in existing single-family
dwelling as applied for. Additional certification will be required.
At premises located at:
870 Village Ln, Mattituck
SCTM # 473889
Sec/Block/Lot# 114.-6-16
Pursuant to application dated 3/1/2017 and approved by the Building Inspector.
To expire on 9/9/2018.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $800.00
CO -ALTERATION TO DWELLING $50.00
Total: $850.00
B ns r
xForm No.6
TOWN OF.SOIJT)Fl®LD
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 I%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. Fern
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$15.00
Date. ®2 Z aP
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 0 7 ® p/ t✓C G
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000,Section l Block `► 0 Co Lot �w
Subdivision- Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temp Certificate Final Certificate: (check one)
Fee Submitted:$
APV
p is Signature
p� SOVj�,®l
Town Hall Annex Telephone(631)765-1802
54375 Main Road Avg ev Fax(631)765-9502
P.O.Box 1179 �� roger.richert(aD-town.Southold.ny.us
Southold,NY 11971-0959
C®UN
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To. Horan
Address: 870 Village Lane City: Mattituck St: New York Zip: 11952
Building Permit#: 41413 Section: 114 Block: 6 Lot: 16
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: "AS BUILT' DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service Only
Commerical Outdoor 1 st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 9 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors 1
Main Panel A/C Condenser Single Recpt Recessed Fixtures 6 CO Detectors 1
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency FixtureTime Clocks
Disconnect Switches 6 Twist Lock Exit Fixtures 9 TVSS
Other Equipment- "AS BUILT" - "ELECTRICAL SURVEY" - "NO VISUAL DEFECTS"
Notes: 1- Exhaust Fan
Inspector Signature: Date: April 13, 2017
0-Cert Electrical Compliance Form.xls
.K \
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold;NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CE T, lUICATION
Date• . 07° /7_
Building Permit No.
Owner: -a;4 Pa,
(Please print)
Plumber: �riayY_ G✓ lf_�
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
bers ignature)
Sworn to before me this
day of 7i"( 20 1'7
p i
&a Notary Public, C�urlty
CASEY L.RYCKMAN
NOTARY PUBLIC,STATE OF NEW YO K
Registration No.OIRY6216402
Qualified in Suffolk County
Commission Expires Jan. 19,20
OE SObTyolo
H 0
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) N, ELECTRICAL (FINAL)
REMARKS:
�( G_ ��
DATE l INSPECTOR 1�-
OE SOloom,
(/T�o6
�o
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] SULATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: 0e4tA 0-ct
n
DATE y0'l INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(1ST) y
--------------------------------
FOUNDATION (2ND) 1
0
yy 9
�r s
C/1
ROUGH FRAMING&
PLUMBING
. (b
INSULATION PER N.Y.
STATE ENERGY CODE
'f l P-
t P,l is vrr
All At
Un
FINAL
r
ADDITIONAL COMMENTS
i
0
CAS
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y
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)765-1802Planning Board approval
FAX:(631)765-9502 Survey
SoutholdTown.NorthForlc.net PERMIT NO. Check
Septic Form
N.Y S D.E C.
Trustees
C 0 Application
Flood Permit
Examined 20L Single&Separate
Storm-Water Assessment Form
Contact:
Approved 20_a Mail to-
Disapproved a/c
Phone,
D Dkmyo= 20
DB 'ding I actor
MAR _ 1 2017 APPLICATION FOR BUILDING PERMIT p
Date dZ ZV 20
BUMDWG DEPT- INSTRUCTIONS
TOWN UFAS9M9, 1R 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,age ,architect ngineer,general contractor,electrician,plumber or builder
Name of owner of premises rlq
(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 Od on which proposed wok will be done-
6 V 1 L c G X ( 4;x�,F-- APs r� 7-C-k-
House Number Street J Hamlet /I
County Tax Map No. 1000 Section I Block 06 Lot
P
+ Subdivision Filed Map No. Lot
2. State existing use and occupancy y premiserd tZn e a c y prop- ons ction:
a. Existing use and occupancy .�( (� 177&,AG
b. Intended use and occupancy 94fif tc_
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work�ff/C' e��
(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 mixed occupancy,s ecii nature and extent of each type of use.
D5 ir 11i;0
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction:Front Rear Depth
Height Number of Stores
9. Size of lot:Front S Rear y� Depth
10.Date of Purchase Name of Former Owner
11.Zone or use district in which premises are situated 'e4 6
12.Does proposed construction violate any zoning law,ordinance or regulation?YES NOV
13.Will lot be re-graded?YES NO-Will excess fill be removed from premises?YES NOA114
14.Names of Owner of premi s Address Phone No. 04E 0
Name of Architect Lv 'L 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 QUIRED.
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)
COUNTY OF Sv t-lL
jAZWK 'rCZ- being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contraco ab ve named, CONNIE D.BUNCH
Notary Public,State of New York
(S)He is the A& C 6t? No.01 SU6185050
(Contractor,Agent, orpo ate Office etc.) Qualified in Suffolk Ceunty
Commission Expires April 14,i0kk
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 q�
day of Chi 20� --�——
Yv�J
Notary Public Signa a of Applicant
f
o��Of SO�jlyOf
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Town Hall Annex � Telehone(631)765-1802
54375 Main Road
P.O."Box 1179 G r0 end pert 3 0
Southold,,NX 11971-0959 O
�yCp�y,N� D i
MAR 2,3 2017
BUaDING DEPARTMENT {
TOWN OF SOLTMOLD B !
APPLICATION FOR ELECTRICAL INSPECTION
T®OFSO ®LD
REQUESTED BY. Ta+ticL&, Date:
Company Name:
Name:
License No.: 4
Address: j
Phone No.:
JOBSITE INFORMATION:t -1(*Indicates required information)
*Name:
Ea+V ,0V-d-n 1
*Address: ?�0 y l tL"pe- (,4 � (Uy LaSz—
*Cross Street: a
*Phone No.:
Permit No.: +
Tax-Map District. 1000 Section:-11, l - Block: Lot:
!
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) _ (+ ,�VLLm,"k-�
(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 I -
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
q
82-Request for Inspection Form
{
FSO � �®
�0 l/jyQlo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G • Q
Southold,NY 11971-0959 �Q a
April 25, 2017
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Patricia Horan
870 Village Lane
Orient NY 11957
TO WHOM IT MAY CONCERN:
The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy:
Application for Certificate of Occupancy. (Enclosed)
Electrical Underwriters Certificate.
A fee of$50.00.
Final Health Department Approval.
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.
Final Storm Water Runoff Approval from Town Engineer
BUILDING PERMIT — 41413- Basement alteration
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MAP OF V1 L-L&C F_
FIL&D: Oc.T• 24 ,1`1!02 !NP Ido. 3&(o9
TV�T +, UNAUI•HORILED ALI E SURVEY
OR
E AT: 'STT 1 TU LIL ,-r ADOIPIIO TX) THIS SURVEY A
VIOlAl1UN OF SECTION 72U9 OE 7'HE NE W
�''� yy..,, "a`'• YORK SIAT E EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT
/j°• �� ° I-� t BEARING THE LAND SURVEYORS INKED
-amu FFo�1c Co V NT /r� SEAL OR EMBOSSED SEAL SHAM.NOT BE
y , /��,� 1��� '1r(�`� �,I ��S{� CONSIDERED TO BEAVAUDTRUECOPY
� rc F� i�:� e• Q_D `,
GUARANTEES OR CERTIFICATIONS
(J IZ 7 �� �• INDICATED HEREON SHALL RUN ONLY TO
y��: M•.y 7-4 «q q :, .i :. „", � `
• ■ • t. 2 r} n�f•I7 t THE PERSON FOR WHOM THE SURVEY IS
,p. PREPARED,AND ON HIS BEHALF TO THE
GER-T I F rr- ,•��•a. ,;,
TITLE COMPANY, GOVERNMENTAL
AGENCY AND LENDING INSI'ITUI-ION
�� LISTED HEREON,AND TO THE ASSIGNEES
�'r�o111^L LA-j-D TF-M u RI
E Co. L-L C_ OF THE LENDING INSI'IPUCION
�I 'e'I f! (" �';c`�- '•J=i GUARANTEES OR CERTIFICATIONS ARE
CHIC^(=0 �)d�+av •.�`i� NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS.
NO PHYSICAL EASEMENT ON PROPERTY
UNLESS NOTED, RECORDED EASEMENTS
OR RIGHT OE WAYS,IF ANY NOT SHOWN,
ARE NOT CERTIFIED.
WALLACE T. BRYAN
LICENSED LAND SURVEYOR
39 PAULANNA AVENUE,BAYPORT,NY 11705
•I ' TELEPHONE(516)472-1770
'S c. CL •,1 = 40 6c.-rrr1: l000 - 114.00 - oCo.00 -ojlo°000
AP R VED AS NOTED -
DATE: B.P.4 � -Z-- PLUMBER CERTIFICATION
FEE: -ilo BY: _`ON LEAD CONT�ivT PE��;r tE
NOTIFY BUILDING DEPARTM AT CERTIFICATE�j�:c.�r CUp/�NCY
765-i 802 8 AM TO 4 PM FOR THE SOLDER t ' JV,tJ
� ViiA TER
FOLLOWING INSPECTIONS: SUPPL Y SYS)L,•v; C%AI v`NOT
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE 'EXCEED 2110 OF I% LEAD.
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
'BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE ALL PLUS ICING WASTE
REQUIREMENTS OF THE CODES OF NEWi�&WATER LINES NEED
YORK STATE. NOT RESPONSIBLE FOR _Ti' INGBEFQ. COWERING,"I'l-
DESIGN OR CONSTRUCTION ERRORS. '- "
ELECTRICAL
COMPLY WITH ALL CODES OF INSPECTION REQUIRED
NEW YORK STATE & TOWN CODES
AS REQUIRED AND CONDITIONS OF
SCufih� RETAIN STORM kNATER RUNOFF
D PURSUANT TO CHAPTER 236
OF THE TOWN CODE.
OCCUPANCY OR
A'6 n a 0 Cerci-�c�'�rI
USE IS UNLAWFUL mot 6e. re It i r�e--J.
WITHOUT_CERTIFJCATE
OF OCCUPANCY
REVISIONS: 1,
HEALTH 00/0012OD9
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BASEMENT PLAN � - ��-.�¢ S}TEETTIUAiBER.
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SCALE: 1/4" = V TOWN OF SOUTHOLD A-1