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Home My WebLink About29025-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPD=RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29165 Date: 01/07/03 T~fS CERTIFIES that the building AC/FURNACE UNIT Location of Property: 2555 OLD ORCHA~RD RD EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 37 Block 6 Lot 6.1 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 19, 2002 pursuant to which Building Permit No. 29025-Z dated DECEMBER 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 INSTALLATION OF CENTRAL AIR CONDITIONING UNIT A/qD NEW FURNACE IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS BUILT" ·"ne certificate is issued to RALPH MARTIN, JR. (OWNER) of the aforesaid building. SIIFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL C~TIFICA~E NO. PLZ~WBERS CERTIFICATION DATED Rev. 1/81 N/A 1067622 07/30/02 N/A Author[zed S ig~t ~r~ 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. 29025 Z Date DECEMBER 19, 2002 Permission is hereby granted to: RALPH JR MARTIN PO BOX 203 EAST MARION,NY 11939 for AS BUILT INSTALLATION OF AN AIR CONDITIONING UNIT AND FURNACE AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 037 pursuant to application dated DECEMBER Building Inspector to expire on JUNE Fee $ 300.00 2555 OLD ORCHARD RD Block 0006 19, 2002 and approved by the 19, 2004. ~~ig~ature EAST MARION Lot No. 006.001 Rev. 5/8/02 ORIGINAL 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: 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. Bo 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. Co Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, 3. 4. 5. Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. Certificate of Occupancy on Pre-existing Building - $100.00 Copy of Certificate of Occupancy - $.25 Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Location of Property: House No?'~ Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Old or Pre-existing Building: Street (check one) Hamlet Subdivision Permit No. Date of Permit. Health Dept. Approval: Block Filed Map. Applicant: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~-~ ~ Underwriters Approval: Lot Lot: Final Certificate: ,~5~he~~.~~ one) ~$~t~ l~t(~'i~ature l BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT ~__Upon the application of upon premises owned by RALPH MARTIN RALPH MARTIN P.O. BOX 203 2555 OLD ORCHARD LANE EAST MARION,NY 11939 EAST MARION, NY 11939 ~ Located at 2555 '"' "' "' ........ LANE EAST MARION, NY i1939 Application Number: 1067622 Certificate Number: 1067622 Section: Block: Lot: Building Permit: BDO: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, Attached Garage, Outside, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found to be in compliance therewith on the 30th Day of July, 2002. Name QTY Rate Rating Circuit Type Additional Charges whole house survey No visual defects: an elctrical survey has been made of the exposed electrical equpment in the premises indicated. No obvious unsatisfactory condition was found. seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] ROUGHP~t~ [[ i ~ORAUMNID~ION 2ND [[ ] I~I~.ATIO~NAL N [ ] FIREPLACE & CHIMNEY ~ ~,~ DATE ?/~~INSP TOWN OF SOUTHOLD BUILDING DEPARTMENT T O WI~. HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 Examined /L /'~ / ,20 ?--- Approved / Disapproved a/c / Expiration //~ ,20.~ ~:'-=--, PERMIT NO.c~..C(C~ 5:~-" '~ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 3 sets of Building Plans Planning Board approval Survey. Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Building Inspector Phone: APPLICATION FOR BUILDING PERMIT Date /~/5,9 INSTRUCTIONS ,20 t~2~ a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 ora 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 demotitig~a as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hou~i~9~tecan/~, regulations, and to admit authorized inspectors on premises and in building for necessary inspections. : (.;( /// ,,, .,/. [11 i~ ~t~~~: ' ' (Mailing address of applicant) State whetho~~~" engineer, general contractor, electrician, plumber or builder Sam~~S ~. ROOGH - FRAMING & PUIMffiN{I (As on the tax roll or latest deed) If applicant i~al~]i~, signature of dukv__a!lthorized officer 4. FINAL - CONSTRUOTIO# MUaT THE REOUIREMENT8 OF THE N.Y. Builders Lic~SlitAllk, CONSTRUCTION& ENERGY Plumbers Lic~t~l~o. NOT RESPONSIBLE FOR Electrici~s ~ ~." ---- '=- .... ~ Other Trade's License No. '.?' ' iLAltgFl',,,, ::: CERTIF .ATE OCCUPAiiCY Location of land on which proposed work will be~/d~,~e: House Number Street Hamlet County Tax Map No. 1000 Section ~ r) Block ~' Subdivision Filed Map No. Lot Lot l/ 2. State existing use and occupancy of premises ~)nd intended use and occupancy of proposed constructig, n: a. Existing use and occupancy ¢/'~//]6~ ...,__ b. Intended use and occupancy Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars Addition / Alteration Other Work /4/ff ¢ ~6,,e'/~',¢6~ (Description) (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 Depth Height_ Number of Stories Rear 8. Dimensions of entire new construction: Front Rear Height Number of Stories 9. Size of lot: Front !4 ~ ~? Rear Depth 10. Date of Purchase I q (~' I/9 Name of Former Owner / ~ Depth 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO .iX 13. Will lot be re-graded? YES__ NO X Will excess fill be removed from premises? YES NO 14. Names of Owner ofpremises~ot4 ~,~ ~ ~¢'/~ Address ~t~ 2&~,/--'~6'//~d~'e~Phone No. ~17,2 ,¢~iff(/ Name of Architect Address Phone No Name of Contractor~-'(,/~!l"~[,~/~:.~,,/_,~ Address /(-~¢¢~,'~ ~9~2~v,/t, Phone No. 177 ~ ~":~'¢ 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. PERMI, T/S MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES /~x 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 --- ,, STATE OF NEW YORK) COUNTY OF ) -~¢~1 being duly sworn, ~ a~ys ~ (s)he is the applic~t (Name of individual sing contract) above named, t (S)He is the ~[~ V~ (Co~tractor, Agent, Co~orate Officer, etc.) of said owner or owners, ~d is duly amhofized to perfo~ or have perfo~ ~e~ai$ ~k a~ to make and file tbs application; that all statements contained ~ t~s application ~e tree to the best of his ~ledge A~ b~lief;and~f"the work will be perfo~ed tn the ma~er set fo~h ~n the apphcatlon filed therewith. ~ Sworn to before me t~s - ~ '~¢~ //.~,a~ Public F ~' ~ff(ure of A~t JOYCE M. WILKINS N~e~ Public, State of New York ~ ~22~, Suffolk Coun~ ~ ~i~June 12,