HomeMy WebLinkAbout43801-Z OeO,
o" r" Town of Southold 7/9/2019
P.O.Box 1179
53095 Main Rd
yP Southold,New York 11971
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CERTIFICATE OF OCCUPANCY
No: 40486 Date: 7/9/2019
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 3705 Wells Rd, Peconic
SCTM#: 473889 Sec/Block/Lot: 86.-2-13
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/20/2019 pursuant to which Building Permit No. 43801 dated 5/28/2019
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"WINDOWS IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Groben Paul &Anne Irry Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Oed Signature
��o�guFFnt,r�o TOWN OF SOUTHOLD
BUILDING DEPARTMENT
C* TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
LSSP
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#: 43801 Date: 5/28/2019
Permission is hereby granted to:
Groben Paul &Anne Irry Trust
26 Lotowana Ln
Stony Brook, NY 11790
To: legalize "as built" windows as applied for.
At premises located at:
3705 Wells,Rd, Peconic
SCTM # 473889 '
Sec/Block/Lot# 86.-2-13
Pursuant to application dated 5/20/2019 and approved by the Building Inspector.
To expire on 11/26/2020.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00
CO -ALTERATION TO DWELLING $50.00
Total: $450.00
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Building Inspe
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-
New Construction: Old or Pre-existing Building: (check one)
Location of Proper: ('S UI��L 1 S E G Co. V(��e C O n i C �! _
House No. ` t
Street J Hamlet {�
Owner or Owners of Property�_R Gf t/ V rQ(D-g-u / Gi C G 1V //6[O-e/a
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. V Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
�( Qlvu� SIA -<...-
Applicant Signature
Iof soil
# TOWN OF SOUTHOLD BUILDING DEPT.
COY 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] WSLATIONU
[ ] FRAMING /STRAPPING [ FINAL X)/4 kkA
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:_
6Y L/DATE INSPECTOR
FIELD IN§VFCTf'ON REPORT DATE COMMENTS
FOUNDATION (1ST)
H
....................................
'FOUNDATION (2ND)
O
z"
ROUGH FRAMING&
0 ts-
PLUMBING y
06
INSULATION PER N.Y. y
STATE ENERGY CODE
,
FINAL
- r 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._ `��® 1 Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved 120 Mail to:
Disapproved a/c
Phone-&36 7 y-1— :3 6`$`K
Expiration ,20
CC OVE
Building nspector
MAY 2 0 2019 PPLICATION FOR BUILDING PERMIT
D aliq , 201c�
i`��`1 a 4.Y➢Z 'n X INSTRUCTIONS
TOWN OF SOUT OI�JD
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.
APPROVED AS N101TO JZJ�t�
DATE. . B P (Signature of applicant or name,if a corporation)
FEf .-�v By-
NOTI Y� IIILDWGr"\RTMENT AT
765-1802 8 AM TO'-4P M FOR THE (Mailing address of applicant)
State wh& a��tiC !r Sis 9 �n`ONSIes� eE ent architect engineer, general contractor, electrician, plumber or builder
1. Cag g ,
rn r,ni mrn rn\�f'.�rTF
Name of�.2. RO G _ F i0 & PLUMBINCa
Rgat
4. FINAL - COiJ•`TRUCTlON MUST (As on the tax roll or latest deed)
If applicant is -§g';p,z tioif-,(sl'fAre of duly authorized officer
ALL CONSTRUCTION., SHALL','M'EET THE
e
(N� UI d�titleT:of�C6i iO t@la d r PA N C Y 0
Builders Pffli`NbT'E:: NOT,iRESPONS,IBLE- FOR UNLAWFUL
� � �
Plumbers B jk ffCUNb l G i i USE SS
Electricians License No. i �� ` " �� � i��
Other Trade's License No. O
� � PANUe"Y"
1. Location of land on whichroposed work will be done:
---,—,s -7 Lt) e It s d?• Pe C Q Pt `1 C y
House Number Street Hamlet
County Tax Map No. 1000 Section 9(o Block 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
b. tended use and occupanc 6f a-X 5�a 01 X�j-7 q
� ,�ie p cn crbKebt�
3. Natur of work(check which applicable): New Building
________Addition lteratio , LA
Repair Removal Demolition Other Work
(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, 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 Rear
Depth Height Number ofgxgr�ie° t ;°`: � s F1 /771
8. Dimensions of entire new construction: Front Rear Depth ' f
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner k' N r 'g
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
14.Naives of Owner of premises Address i 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 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 )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named, CONNIE D.BUNCH
Notary Public,State of New York
(S)He is the No.01BU6185050
(Contractor,Agent, Corporate Officer, etc.) Commission Expires April 14,2Q(D
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
5 day of L 20
Notary Public Signature of Applicant
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ANNE R. GROBEN
IRREVOCABLE TRUST
June 2, 2015
ESN : q7- 7004T5v
Prepared by:
Janna P.Visconti,Esq.
Grabie&Grabie,LLP
Attorneys at Law
162 Terry Road
Smithtown,New York 11787
631-360-5600 -
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st and of any trust j
5.1 Identity ointed as Trustee of this Tru
Anne M•Booker is hereby app -H°Oker is unable,unwilling' °T
ise stated. If Anne M
unless otherwise
appointed as successor Trustee of
created under this trust, e V.Dreyer is hereby app le to act,
Trustee'then Jan willing or available
unavailable to act as Tru tee able,
ed successor Tru Trustee
time there is no nam e there is no acting
this Trust• If at any Trustee' If at any time
oint a successor Tru O1nt a Trustee by a majority
then the acting Trustee must app '
ainder beneficiaries may pp res ective share of
a a
Or successor Trustee then living,the rem
o voting in proportion to his or her p
through a pent,legal guardian' or , t
each adult remainder beneficiary I ,,1
decision, beneficiaries voting of be
or or incapacitated b Trustee may n
Trust estate(min provided that the such
the Tru "4
Me for beneficiary) p 6�2(c)•
of valid Power of attorn Y earring of 26 U.S.
C. Sec.
holder
within the m
beneficiary ,
related or subordinate to any
1„
d Duties of Trustee shall have the
5.2 powers an successor Trustee)
Including any held in such
Trustee hereunder( real or personal,
The Tru Property ,
Power to deal with any p cent �
absolute, discretionary p riot or subsequent
continuing, cised independently and without the p
ower maybe exec with such Trustee shall be
Trust(s). Such p erson dealing
and no p The Trustee shall not
court or Judicial authority, Trustee.approval of any o f any o f the actions of such Tru funds of
a invest the
required to inquire into the Propriety which he or she May
- e type and character of investments in d judgment
in the selection of
be limited to th yp rudence an J
long as the Trustee uses reasonable p
this Trust, so and not by
addition to,
investments lowing general powers'
in powers
The Trustee shall have the fol �l•1 o f the New�,ork Estates,
way of limitation of,
the p°Vers provided by Section 11
s s °T any successor statute thereto:
and Trust Law, 11
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PAUL V. GROBEN
IRREVOCABLE TRUST
May 15, 2015
SIN
X7. 70& [ gd I
Prepared by:
Janna P.Visconti,Esq.
Grabie&Grabie,LLP
Attorneys at Law
162 Terry Road
Smithtown,New York 11787
631-360-5600 -
5.0 TRUSTEES
5.1 Identity {
j,
Anne M. Hooker is hereby appointed as Trustee of this Trust and of any trust
created under this trust, unless otherwise stated. If Anne M. Hooker is unable, unwilling,or
unavailable to act as Trustee, then Jane P. Dreyer is hereby appointed as successor Trustee of
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this Trust. If at any time there is no named successor Trustee able, willing or available to act,
then the acting Trustee must appoint a successor Trustee. If at any time there is no acting Trustee
or successor Trustee then living, the remainder beneficiaries may appoint a Trustee by a majority
decision, each adult remainder beneficiary voting in proportion to his or her respective share of
the Trust estate.(minor,or incapacitated beneficiaries voting through a parent, legal guardian, or
holder of valid power of attorney,for such beneficiary),provided that the such Trustee may not be
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related or subordinate to any beneficiary within the meaning of 26 U.S.C. Sec. 672(c).
5.2 Powers and Duties of Trustees
- I ,
The Trustees hereunder(including any successor Trustee) shall have the
continuing, absolute, discretionary power to deal with any property, real or personal,held in such
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Trust(s). Such power may be exercised independently and without the prior or subsequent
approval of any court or judicial authority, and no person dealing with such Trustees shall be
required to inquire into the propriety of any of the actions of such Trustees. The Trustees shall
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not be limited to the type and character of investments in which he or she may invest the funds of
this Trust, so long as the Trustees use reasonable prudence and judgment in the selection of
investments.
The Trustees shall have the following general powers, in addition to, and not by
way of limitation of, the powers provided by Section 11-1.1 of the New York Estates, Powers
and Trusts Law, or any successor statute thereto: i
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11 +'
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