HomeMy WebLinkAbout36781-Z ��SUFFpt,fco Town of Southold Annex 11/10/2011
54375 Main Road
y a� Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 35283 Date: 11/10/2011
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property: 1165 Theresa Dr;Mattituck,
SCTM#: 473889 Sec/Block/Lot: 115.-15-11
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
10/21/2011 pursuant to which Building Permit No. 36781 dated 10/28/2011
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"alteration of existing garage to bedroom and bathroom in an existing one family dwelling as applied for.
The certificate is issued to Berliner,Donald&Berliner, Sandra
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 36781 10/28/11
PLUMBERS CERTIFICATION DATED 9/24/11 Nyttituck Plumb' g&Heating
A�
o ' ed S'gnature
= FD��-F TOWN OF SOUTHOLD
g11FCo�'y
BUILDING DEPARTMENT
y a TOWN CLERK'S OFFICE
o . SOUTHOLD, NY
terra
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#: 36781 Date: 10/28/2011
Permission is hereby granted to:
Berliner, Donald & Berliner, Sandra
1165 Theresa Dr
Mattituck, NY 11952
To: convert garage to conditioned space "as built"
At premises located at:
1165 Theresa Dr, Mat tituck
SCTM # 473889
Sec/Block/Lot# 115.-15-11
Pursuant to application dated 10/21/2011 and approved by the Building Inspector.
To expire on 4/28/2013.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $579.20
.CO -ALTERATION TO DWELLING $50.00
Total: $629.20
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 farm).
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%dead. .
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.OG,
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.
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 5 1 juAe-�
House No. Street Hamlet
Owner or Owners of Property: h„}_ d g- s�
Suffolk County Tax Map No 1000, Section Block /-5— Lot /
Subdivision Filed Map. Lot:
Permit No. .3 4P ��. Date of Permit. / `2 s - ) Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (chec o e)
Fee Submitted:
pplicant ignature
pF SOUryolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
GX, • �� roger.richert a�town.southold.ny.us
Southold,New York 11971-0959 �
�y��UNTY,N�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Donald Berliner
Address: 1165 Theresa Dr City: Mattituck St: NY Zip: 11952
Building Permit#: 36781 Section: 115 Block: 15 Lot: 11
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 X 2nd Floor Hot Tub
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 Exit Fixtures TVSS
Other Equipment: convert attached garage to living space (bed room & bath room)
Notes:
Inspector Signature: Date: Oct 28 2011
81-Cert Electrical Compliance Form
i
. I
I • ti �
r. Hall, 53095 Main Road 0
P O Box 1 179 y �, Fax (63 t) 765
\`e .• York 11971•0959 Tcicphone (6] )
t
i
BUILDINC•DEPARTMENT
j TOWN OF SOUTHOLD
4
CERTIFICATI0 N
i
Date: Y �/
G
4 V J
Building Permit No.
I
Owner:
(Please,pnnt)
Plumber:
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of I%
lead.
A4 i
I -
i
11 gnature)
Swom to before me this
f
1 •
o13%0 0 ' 201!/
DENISE KING
Notary Public,State of New York
i Registration #01 K16041757
Qualified In Suffolk County
My Commission Expires May 15,20
I
Noiary Public-
County
i
i
i I
cou
TOWN OF SOUTHOLD BUILDING DEP -
765-1802
� INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) RICAL (FINAL)
REMARKS:
7 _ _
DATE INSPECTOR
' OE SObl�olo
cOUNI'I,�c�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
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)
REMARKS:
_ P
DATE !` ///-INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(IST) J
--------.....------------------
FOUNDATION(2ND) t�
ROUGH FRAAIDNQ&
PLUMBING
INSULATION PER N.Y.
H
STATE ENERGY CODE
' 4
FINAL
ADDITIONAL COMMENTS
'�c• 20
p
44j ltoa�
03 °z
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 proval
FAX: (631) 765-9502 '• Survey
SoutholdTown.NorthFork.net PERMIT NO. � Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined �D ,20 Storm-Water Assessment Form
Contact:
Approved �� ,20 Mail to:
Disapproved a/c
Phone:
Expiration ,20
E E V t Building Inspector
D
OCT 2 0 2011 A ATION FOR BUILDING PERMIT
Date 020 , 20 1 1
BLD INSTRUCTIONS =
TOWN F OF SOUTOUTHOLD
a. This application MUST'be-completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
:,tts 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.
I- t
(Si nature of applicant na e,if a corporation)
v
ail ng addre of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises [c� Rex-L'y')e4,--�
(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 which proposed work will be done:
1`U-P,_ aA ,t�
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot I
Subdivision � ' "moiled 1�Iap-No: G 1 Lot
J� 1� ,.
2. State existing use and occupancy of premises and intended u e and occupancy of proposed construction:
a. Existing use and occupancy e�
b. Intended use and occupancy l `� I/I
3. Nature of work(check which applicable):New Building Addition Alteration V/
Repair Removal Demolition Other Work
(De cription)�g�.
4. Estimated Cost Fee
7 (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 5 Rear ��t Depth N
Heigh# 2 ` `` Number of Stories ,,;7
Dimensions of same structure with alterations or additions: Front �_ 1 Rear
Depth `- " Height Number of Stories QL-
8. Dimensions of entire new construction: Front *�.' Rear Depth 'I
Height ^, i Number of Stories �? Y
9. Size of lot: Front •��I Rear -7 Depth �/2•
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 regraded?YES NO /Will excess fill be removed from premises?YES NO:
14.Names of Owner of premises'r-blo4i R)Lk�AAddress/#,5-1 fl-e. ; 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 NO
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE,I2EQUIRED.
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 ftrvey.
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 ) tt ll
1� being duly sworn,deposes and says that(s)he is the applicant
me of individual signing co tract) above named,
(S)tle is the
(Contractor gent, Corporate Offic r, 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 20jA—
r
Notary Public' Not a 1c,State: New York Signature of Applicant
Pub1
No. 01 TA608600i
Qualified In Suffolk County
.Commission Expires 01/13/20 lLi
® ITECNOLOGIES
ARCffiTEMM PLANNING CONSTRUCTION SBRVICIiS Ej
13405 Main Road,Mattitack, New York 11952 631.298.1129 fax:631.298.1128P.O.Box 93
October 28, 2011
Southold Town Building Department
P.O. Box 1179
Southold, New York 11971
Re: As-built Building Department application
Berliner Residence
1165 Theresa Drive
Mattituck, New York
Attention: Plan Examiner
Per our phone conversation, the as-built garage conversion at the address above met the
N.Y.S. Energy Codes at the time of the actual construction.
QED A
Frank � 7� �o
Fran 'otar__o-3 - ct �g
Ae
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P.O. 5,0293
:�.
Mattituo,�,N�eu 10_w 2
N
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i ofso�
Town Hall Annex Jf Telephone(631)765-1802
54375 Main Road G a (63 )76Jn515
.wUl�OOOP.O.Box 1179 roger.richert nS ny.us
Southold,NY 11971-0959 'Ql� �O
� �OUIYTY�
BU�DING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FC R ELECTRICAL INSPECTION
i
H
REQUESTED BY: Date:
Company Name:
I
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicaxes required information)
*Name: b"J AIS
.�--
*Address: S� `Vg C NY
'`Cross Street:
*Phone No.:
Permit No.:
Tax-Map District: 1000 . .Section: Ltd Block: /S Lot: f/ `
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) ►t�S �`� �►MOC I
i .
(Please Circle All That Apply)
*Is-job ready for inspection: ES NO Rough In final
*Do-you need a Temp Certificate: ± YES !�
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 1 100 150 200 300 350 400 Other
i
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
I
j
.82=Request for Inspection Form 1 �,► �!V
v1 \
NOTE:
CONTRACTOR TO NOTIFY THE ARCHITECT rTl V
OF ANY AND ALL REVISIONS DUE TO FIELD w
CONDITIONS, CLIENT,AND OR GENERAL
CONTRACTOR WHICH DIFFER FROM THE
CONSTRUCT. DRAWINGS/SPECIFICATIONS. Z
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EXISTING GARAGE CONVERTED TO HEATED EXISTING GARAGE CONVERTED TO HEATED
0 3
(HYDRONIC BASE.BD.)BEDROOM/BATH
(HYDRONIC BASE,BD.)BEDROOM/BATH
W rn z
EAST ELEVATION WEST ELEVATION SOUTH ELEVATION Q
(EXISTING) (EXISTING) W(EXISTING)
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2 -2"X 10"JOIST SUPPORT BOLTED EXISTING GARAGE CONVERTED T HEATED 0.O I I I
TO ADJACENT PART. CONC. WALL (HYDRONIC BASE.BD.) /BATH (�
(TYP. BOTH SIDES)
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EX EX IL
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U WTI U EXISTING EXTERIOR/INTERIOR WALL TO REMAIN.
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(0 D t0 J 1 it n.,"
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T ?3 Q Ex EXISTING WINDOW/DOOR/GARAGE DOOR TO REMAIN. P EF I ® �I
LL W I &C.H. I
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o � O NEW 2-8 X 6-8 DOOR TO MATCH EX. i ����'�- �i ,• -,
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NEW 2'-6" X 6-8" DOOR TO MATCH EX. _. ' -'.. a: . rE
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N N iv O NEW 5 O X 6-8 BI-FOLD DOORS TO (MATCH EX. _ ®SD __ __ _ PLUMBER CERTIFIC,�T10
L4 I±_I'I I I I===1 L-1 I_1 ® PROVIDE ALL NECESSARY PLUMBING ROUGHIING AND VENTING AS — � '� —
P INDICATED ON CONSTRUCTION PLANS. FOLLOW ALL NECESSARY O // ON LEAD CONT&,lT F FO
N.Y.S. AND LOCAL PLUMBING CODES THAT APPLY TO WORK TO BE CERTIFICATE OF 0Ci'LVPA
COMPLETED. PROVIDE ALL NECESSARY DRAIN VALVES FOR
WINTERIZATION. REF. TO CONSTRUCTION PLANS FOR FIXTURE TYPES. Ex SOLDER USED 1; _ TE
ALL WASTE LINES ARE TO BE INSULATED WITH SOUND ATTENUATING SUPr R_Y .., � ,�,�/;�; , .,,„ • d0
ALIGN FINISH FLOOR W INSULATION (TYP. ALL AREAS) EXCEED�'1I Q (�i`-
ADJ. EXISTING FLOOR HT. A
(p DUPLEX ELECTRICAL RECEPTACLE
(tGFI DUPLEX RECEPTACLE/GROUND FAULT INTERRUPT
$ WALL SWITCH v
APPROVED�� NOTED
DOWNLIGHT (100W) " LIGHTOLIER" OR APR. EQ.
O INTERIOR RECESSED WATER-PROOF DOWNLIGHT (100W) DATE
EF NEW CEILING MOUNTED JUNCTION BOX FOR (RECESSED EXHAUST f�E ��/ �, t f/� ? 0
FAN/LIGHT WITH DUAL SWITCH AT WALL. BRO)AN HEAVY DUTY UNIT -'�—rBY ( w
OR APP. EQUAL. � '
NOTIFY BUILDING DEPARTMENT A (p
...1 ;65-1802 8 AM TO 4 PM FOR THE �
®SD SMOKE/CARBON MONOXIDE DETECTOR: TO BE WIRED TO CENTRAL I ' FOLLOWitdG INSPECTIONS:
CONTROL BOX. 1. FOUNDATION-TWO REQUIRED F
FOR POURED CONCRETE a
2. ROUGH-FRAMING,PLUMBING, w
STRAPPING,ELECTRICAL&CAULKINIG 0
3 INSULATION' Z
Z
4 FINAL-CON'STRUCTION&ELECTRICAL w 0
I`lIJSI`BE COMPLETE FOR C 0
EX EX EX EX ALL CONST U T SHALL MEET THE J
.,�,��0t� co
�
RE66fk h` T At%gHE CODES CC NFV'd 0 0
frI) ICON# Y 5'C�NSIBLE FCC
CONSTRIQN ERRORS D D
LL O LL LL
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PART. DECK FRAMING PLAN PART. PLAN SCALE:
1011
ELEC RICAI- 1/411
(EXISTING) (EXISTING) _
40 R C E SET DWG. NAME:
6.6. 1 1 �`' COMPBOS TE
PLAN/ELEV.
THESE DRAWINGS AS INSTRUMENTS OF SERVICE, DWG. NO.:
ARE THE SOLE PROPERTY OF THE ARCHITECT.NO
REVISIONS,CHANGES,AND/OR MODIFICATIONS
SHALL BE ALLOWED W/O WRITTEN AUTHORIZATION
BY THE ARCHITECT. ANY REPRODUCTION IN PART A- 1
OR WHOLE IS STRICTLY PROHIBITED BY LAW.
- - ------------
NEW SUFFOL101� AVENUE
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• �'- SITE SURVEY
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MAP OF PR OPER T Y
SITUATED: MATTITUCK, NEW YORK
� 2
TOWN OF. SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. MAP-0700-23-2-36
CERTIFIED TO: BEN MENDOZZA
LOT NUMBER 36 "DEEP HOLE CREEK"
SURVEYED 7-29-76
_ AREA = 22, 178 S.F.
SCALE 1 Z 1 6 " 1 '
y\� ;\,} A���, INFORMATION TAKEN FROM SURVEY
A1
m) � PREPARED BY YOUNG & YOUNG, P.C.
499 OSTRANDER AVE.
RIVERHEAD, NEW YORK
p 0 CO ISSUED: ISSUED:
D PROPOSED "AS - BUILT" ALTERATION
ITECNOLOGIES
(A � r ISSUED TO CLIENT TO THE
1 m 10.6.08 FOR REVIEW. ;. - - : ,,
rnz -I z � /.
- ISSUED TO BUILDING DEPT. . %iii "/ .. .. ... . .
V / ic 10.20."11 i., /;. /
FOR REVIEW. BERLINER RESIDENCE
ARAITECTURE�r� %i /, � C PLANNING CONSTRUCTION SERVICES
P.O.Box 93 Mattituck, New York 11952
Z = MATTITUCK NEW YORK ,� ' ' '
'� /j , `' , '% / ;'/ 631.298.1129 Fax: 631.298.1128