HomeMy WebLinkAbout42777-Z �o�g�yEFOt,��oGy Town of Southold 7/17/2015
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P.O.Box 1179
d' 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39757 Date: 7/10/2018
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 475 Richmond Rd., Southold
SCTM#: 473889 Sec/Block/Lot: 51.-6-22
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/1/2018 pursuant to which Building Permit No. 42777 dated 6/12/2018
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"bathroom in an existing one family dwelling as applied for.
The certificate is issued to Carrig,Marie
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42553 7/5/2018
PLUMBERS CERTIFICATION DATED
Au o ' e Signature
�gUfFO(�Co TOWN OF SOUTHOLD
��o Gyp BUILDING DEPARTMENT
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#: 42777 Date: 6/12/2018
Permission is hereby granted to:
Carrig, Marie
Richmond Rd
PO BOX 84
Southold, NY 11971
To: legalize as built alterations to an existing single family dwelling (bathroom) as applied
for.
At premises located at:
475 Richmond Rd., Southold
SCTM # 473889
Sec/Block/Lot# 51.-6-22
Pursuant to application dated 6/1/2018 and approved by the Building Inspector.
To expire on 12/12/2019.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $443.20
CO -ALTERATION TO DWELLING $50.00
Total: $493.20
Building Inspector
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 G
Date. 0
New Construction: Old or Pre-existing Building: V (check one)
Location of Property: y7 tic lal_ 04 d (Q �OLJ//1 b[
House No. n Street Hamlet
Owner or Owners of Property: GL/yL /
Suffolk County Tax Map No 1000, Section Jam" / Block C1 Lot vZ v?
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9502
P.O.Box 1179 ® �Q roger.rich ert(a)_town.Southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Carrig (Dickerson)
Address: 475 Richmond Road city;Southold st: New York zip: 11971
Building Permit#: 42777 Section: 51 Block: 6 Lot: 22
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 Service Only
Commerical Outdoor 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceding Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 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 Fixture Time Clocks
Disconnect Switches Twist Lock Exit Fixtures 11 TVSS
Other Equipment: "AS BUILT' - "ELECTRICAL SURVEY' - "NO VISUAL DEFECTS"
Notes: As Built Bathroom
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Inspector Signature: Date: July 5, 2018
0-Cert Electrical Compliance Form.xls
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ULATION
[ ] FRAMING / STRAPPING [V] FINAL
[ ] FIREPLACE & CHIMNEY [ ] .FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
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(-)Y ('
DATE INSPECTOR
SOUTy�
* # TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [FINAL
k;����
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
IL 04ktwJ
DATE INSPECTOR
OF 50UlyOlo
# TOWN OF SOUTHOLD BUILDING DEPT.
°`ycou765-1802
INSPECTION
( ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE �� INSPECTOR�r
A
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(IST) H
--------------------------------------
'FOUNDATION
-----------------------------------'FOUNDATION (2ND)
O
ROUGH FRAMING&
PLUMBING
S
INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
on 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
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.-
Trustees
C.O.Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
1� Storm-Water Assessment Form
Contact:
Approved 20 •�`� '�U���zy�.A �if��/'sni-i
Disapproved c
TOS O — Phone: /
Expiration 1'Z xci
Building Inspector
APPLICATION FOR BUILDING PERMIT
r
c1un� / , 20
INSTRUCTIONS Date
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
shal l 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 Dlepartment 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)
X80 /Yl�,./ • l� �at7��� !�y_
(Mailing addr s of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises moi'
(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 Traded.License'Nd:;
1. Location;of larid�,o11ME 10h.p oposed work will be done:
z Al 119 7
House Number Street Hamlet
County Tax Map No. 1000 Section Block f�,/ Lot �o�
Subdivision riled Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy_moi no l i _-Pn 0 .
b. Intended use and occupancy S 7
3. Nature of work (check which applicable):New Building rAd'ditiJ)Q%'rC5oVA Alte ation
Repair Removal, Demolition Other Work "
escription)
Estimated Cost Fee
.
(To be paid on filing this application)
If dwelling, number of dwelling units �i r of.dwehngu sineach floor
If garage, number of cars . .
If business, commercial or mixed 66cupancy, specify nature and exAt of ac- pe of use.
,7! Dimensions of existing structures, if any: Front ,., =P;, ` FRearr Depth
Height ..Number of Stories '�'h'
- I
� f ,
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
Dimensions of entire new construction: Front Rear Depth
Height Number of Stories' .
A` Size of lot: Front Rear Depth
,,1<Date of Purchase Name of Former Owner
1
one or use district in which premises are situated
JeDoes 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
14. Names of Owner of premises Address Phone 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? *YES <-T NO
* IF YES, SOUTHOLD TOWN TRUSTEES'& D.E.G. PERMITS MAY 13E 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 ,
�� yr LJ;�KP�sde� being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,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. TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
Sworn to before me this NO.olDW6306900
da f 20 QUALIFIED IN SUFFOLK COUNTY
y oCO MISSION EXPIRES JUNE 30, �
Notary Public Signature of Applicant
W � o
$11fF01��, BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road {� V l5
00
0 Southold, New York 11971 9 D
Q � p�� Telephone (631) 765-1802 - FAX ( 7655023 201$
roger.richert(cr)town.southoId.ny.us
APPLICATION FOR ELECTRICAL INSPECTION BUMDINGDEPT.
TOWN-oy
REQUESTED BY: - _ _ "- - _ -_" _ - Date: - -
Company Na e:
Name:
License No.:
Address:
Phone No.:
JOB SITE INFORMATION: (All Informatio Required)
Name: C f
Address: -RichfflaVD6 'ICA
Cross Street:
Phone No.: 1p 1 502.A C5 a I
Bldg.Permit#: ? t mail:
Fax Map District: 1000 Section: Block: (a Lot:
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
aAN- rocrm ,�on
Circle All That Apply:
Is job ready for inspection?: YES / NO Rough In Final
Do you need a Temp Certificate?: YES / NO Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A # Meters Old Meter#
New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
Request for Inspection Forrn.xls
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