HomeMy WebLinkAbout26790-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27611 Date: 04/09/01
THIS CERTIFIES that the building ALTERATION
Location of Property: 9525 NASSAU POINT RD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 119 Block 1 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 1, 2000 pursuant to which
Building Permit No. 26790-Z dated SEPTEMBER 22, 2000
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 ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DAVID R BERGEN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. PENDING 03/01/01
PLUMBERS CERTIFICATION DATED 03/21/01 K&K PLUMBING & HEATING
uth rized Signature
Rev. 1/81
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. 26790 Z Date SEPTEMBER 22, 2000
Permission is hereby granted to:
DAVID R BERGEN
BOX 1008
CUTCHOGUE,NY 11935
for
ALTERATION TO AN EXISTING 4 BEDROOM SINGLE FAMILY DWELLING AS
APPLIED FOR.
at premises located at 9525 NASSAU POINT RD CUTCHOGUE
County Tax Map No. 473889 Section 119 Block 0001 Lot No. 002
pursuant to application dated AUGUST 1, 2000 and approved by the
Building Inspector.
Fee $ 249 .00
thortized Signature
ORIGINAL
Rev. 2/19/98
^A 100 Do
Form No. 6
/) 1935
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector 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.
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 a 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 $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building ,$25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildine - $100.00
3. Copy of Certificate of Occupancy - .25%0
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . . . . .�3. 1)./d. �. . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . .C.. . . .. Old Or Pre-existing Building. .
Location of Property. . ! S-1 T- . . . n 2� C` 1.(P* °:1-. . . . . . . . .
: . . . . . � . . . • . . . . . . . . . . . :.
House No. Street
(( rz Hamlet
Onwer or Owners of Property.. . .gCx,.v,.0 1Jc? •:�lePN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c� , .
County Tax Map No 1000, Section. . .0 . .I. . . . . . .Block. . . . .I . . . . . . . . . .Lot. . ._�r. . . . . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ./Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. .�.L.6 7.Cf.� . . . .Date Of Permit. .��?fU . . .Applicant. . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . .. . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
-Punning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. . . . . . . .. . . . . . .. . . . . . . . . . . . . .
cs�,�,. s 9 as�►� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C'o a�G I I APPLIC
o�OS�FF04coG
Town Hall, 53095 Main Road y Z Fax(516)765-1823
P. O. Box 1179 �G • Telephone(516)765-1802
Southold, New York 11971
Bio! 41 �a
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE: tz ( ( o l
Building Permit No.
Owner: `C)a,-,?A e
fiq
(please prin
Plumber:
(pl ase prinyy
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plumbers Signature)
Sworn to before me this
day of Yna& 19 02,00e,
Notary Public, /� County
s-^.°p01G S.G10J. LINDA J.COOPER
A1un �lla44nS"£95ZZab'ON Notary Public,State of Nevar York
Mn yo e1etS'oli4nd AJeloN No.4E22563,Suffolk County
HU003*r VGNll Terra Expires December 31,?9j;100 y
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy because of the
following reasons:
X An application for Certificate of Occupancy is not on file.
(Enclosed)
X No Underwriters Certificate on file.
X The check is (not on file).
No Health Department Approval on file.
No final inspection has been made.
X No Plumber Solder Certificate on file.
(All permits involving plumbing being issued after April 1, 1984).
BUILDING PERMIT # 26790 Z
Please contact our office on this matter. Thank you for your cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1INI IZGY CODE CALCULATIONS
(For Nota-Electric cleat) Desiyn Criteria 6 , 000 Uegree' Ual's
O.A. 1U°F I .A. 7UOF
04 �, d 1�e• g e1, PER: nth,~y ����� 2 08 S 'f
FOR: '_�
�v 4'.SS 4L, POI w
C� c oye DATED•
11RL'11 DESIGN TIIERMGL REMARKS
SUBSYSTEM U ILr%TlNG
t:xLeri.ot: Walls (Opaque) leIL . O� +-G 6
-
Gl,zi►ty 2l 45'0 .3Z 22 0.- CPO?/
Doors
T
i
Ceiliny/Roof (opaque) �2S
. 0 >
0
Skyliyht•s $
Floor 05" d
I'oundat-ion Walls
Slab Insulation
TOTAL
NoL•es :
13uilc(lny Envelope Systems to meet requirements of 7015. 2
IIVAC Equi.pement to meet requirements of 7015 . 11
HVAC Systems to meet requirements of 7815 . r2
Duct Systems to meet requirements of 7015 . 13
Ventilations Systems to meet requirements of 7015 . 14
lttsu:lat•ion of piping Systems to meet reyuir.emenLs of 7015 . 15
Service Water Heating Systems & Equipment to mecL- requirements of 7015 . 21
1,.lect•.rical & Lighting Systems & Equipment- to meet requirements of 701.5 . 31
NEW Y
0
To the best of my knowledge, ��Q�NCE
belief, & professional Q ��
judyentent, these plans are 1.11 cc
compliance with L•he code.
' 0 032254-1 �V
p90�ESS%O
615-
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f7-34-(P7i 1�
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STATE OF NEW YORK )
ss:
COUNTY OF SUFFOLK ) /
a w r �"�� l 1, being duly sworn, deposes and says:
Tha deponent , over the age of 18 years and resides at
That on the day of ����s , 2000 deponent architect/engineer,
licensed by the State of New York, hereby states that s/he accepts full
responsibility for the accompanying plans compliance with the New York State
Fire Prevention and Building Code (9 NYCRR); said plans pertain to property
located at SCTM# 1000- 1 `l— t V-I. ,
street address Po, C����o3
ArGh4teet/Engineer
OF NEW Y
CE
Sworn to before me this *S�'��Nrr✓��9f
l day of 12000. �j a
p t` 032264-1 aC�
Notary Public ESSIG
WIN S.SANTOFtA
NOTARY PUlLIC.5taie of Now York
No.30-I916ois
QWUR1d Nasrny C y�
Cemmon Expi1
fd
cc: Applicant �t
'' ' AUG 3 2000
1>VI D Jv0
�i
STATE OF NEW YORK )
) ss:
COUNTY OF SUFFOLK ) /
Q�✓ ��� M �� l/ being duly sworn, deposes and says:
Thaf.d ponent 's over the 2ge of 18 years and resides at
de
Cay eeh '3" MY
IV
That on the day of A �s , 2000 deponent architect/engineer,
licensed by the State of New York, hereby states that s/he accepts full
responsibility for the accompanying plans compliance with the New York State
Fire Prevention and Building Code (9 NYCRR); said plans pertain to property
located at SCTM# 1000- 1 ( `l-- t --J,-
street address cfSa-S' n ssa�. Pv 7-rid,#C+��e34� n
ArGh*eet/Engineer
(�of NEw r
SSP INCE TCi O9'f'
Sworn to before me this
l day of , 2000.
03n�s.,
Notary Public 9�FESSIONP�'
"'IMS.SANTORA
NOTARY PUILIC,Srars oI No*York
N.30.4916018
Qwliliod inCou �y C
Canmimion
cc: Applicant
' AUG 3 2000
suiwINc oar.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH P G.
[ ] FOUNDATION 2ND [ ] IN TION
[ ] FRAMING [ FINAL
( ] FIREPLACE CRIM`P' JY
V
REMARKS:
,DATE 3 1 0/ INSPECTOR �^'G,
7 ?61
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROU LBG.
[ ] FOUNDATION 2ND [ NSULATION
[ J FRAMING [ ] FINAL
[ j FIREPLACE 8 CHIMNEY
REMARKS• 7
,DATE INSPECTOR y�
l
M-1802
BUILDING DEPT. �
INSPECTION
[ ] FOUNDATION IST [ ROUGH PLBG. �
[ ] OUNDATION 2ND [ ] INSOLATION
FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
,DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
/] FOUJNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ) FIREPLACE 8 CHIMNEY
REMARKS:
i
,DATE /oVINSPECTOR �-��
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS: /C-
,DATE I O INSPECTOR
1
I
-- --
UNDAT I ON ( IST) II n
II II
II
-------------------------
UNDATION (2ND) a ii r
-------------- -- _______________________________________________________
if
q__,
UGH FRAME & II------�I -- — �t.
PLUMBING n -
II --11 �JJ
_______________________________________________= r
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1
SULATION PER N. Y. ii IH
STATE ENERGY tl 1
CODE u
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FINAL N ��
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ADDITIONAL COMMENTS:
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FORM NO. 1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . .. . . . . . . . . . . . . . . . . . . . .
p' 1201 '
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
'r SOUTHOLD, N.Y. 11971 DEC ..
10bUi �SCiiTHOLD I
J TEL: 765-1802 TRUSTEES . .. . ....... ... .. .. . . . .
NOTIFY: ? 3 t„G 7/ �,
CALL
Examined...to........, �@.QD MAIL•TO: . . . . . . . . . . . . . . . . .
Approved...jR/Z,?...... oo.. Perna t No. .C .���5!.. Q. 1 c� Q ................
Disapproved a/c .........'............ ............ ..........
f NZ`i'...�, 3
......................................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date.oh. . . . . . . . . . , 20.4
INSTRUCTIONS
a. 'this application must be completely filled in by typewriter or in ink and submitted to the Building Inspector i
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 giving a detailed description of layout of property must be drawn on the diagram which is part of
this application.
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
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 whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATICN 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 rcumal or demolition, as herein
described. the applicant agrees to coldly with all applicable laws, ordinances, building code, housing code, and
r'egc.:ations, and to admit authorized inspectors on premises and in building for necessary inspections.
..... .....................................
(Signature of appl cant t, or name, if a corporation)
13oX 1Oa$ CK_ ...... ....«.`.r x.51.
(Mailing.address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build(
.... 1 . 0.J.0..............................................................................
Name of owner of premises .........
......................
... ...` .....................................................
(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. r?.S...
Plumbers License No. .........................
Electricians License No. .....................
Other Trade's License No. ....................
1. Location of land on which proposed work will be done..................................
...Asa................ �:::.f.. .-............ C ..................
....... ..
House Number Street Hamlet .......
County Tax Map No. 1000 Section ..tr1jj,.7....... Block
Subdivision ...................................... Filed Map No. ............... Lot ............
(Name) ...
2. State existing use and occupancy of premises and int use and occupancy of proposed construction:
r
a. Existing use and occupancy `
....�.`..'�L l.4.. ...............................................
b. Intended use and occupancyt
.... .................................... ...
E:14TATr AMT-"^.It.13
tftuL�":� :i.xirtrt�7
r
3. NatuT,of work (check which applicable): New Building .......... Addition .......... Alteration .
Repair ............ Ramval ............. Demolition ............ Other Work .............................
�• (Description)
4. Estimated Cost ..6. ,.o a........ fee ...............................scrip....
(to be paid on filing this application)• .
5. If ckaelling, number of dwelling units ............ Number of dwelling units on each floor ................
Ifgarage, 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 �?. ,r. K Depth .�11..•........
height ...k r..t.6,....... Number of Stories ......(........ .... ........
Dimensions of same structure with alterations or additions: Front .��..� .$.
�� ... Rear CS-.. ...
Depth .....G .......... Height .................... Number of Stories ..�.
...... ........
ti. Dinensions of entire new construction: Front 3.Q/1.(ff.... Rear 3p r{��rr.,,,, Depth ,Lf 6 r
r ..
Height .......v............... Number of Stories ...I.................
9. Size of lot: Front .......... ......... Rear .................... Depth ....................
10. Date of Purchase ......�. 91.$ Name of Former Owner .mem.-s.c�.;s ,.. �l e:"!�e ........
II. Zone or use district in which premises are situated .................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................
13. Will lot be regraded .................... Will excess fill be removed from premises: YES
14. Names of Owner of premises Q L ..k.i%eCi.......... Address I�?.rS .C` 3�e..... Phone
Name of Ardritect..G�.1`".... ......0...........!.. Address t�n.......
...
Name of Contractor ���....�� ���............. Address c�Z.. ��:t.......Phone No?
15. Is this property within 300 feet of a tidal wetland? * YES .......... NO ..........
*IF YES, SQTIIlr>1D Tadd TMJSIMS PM9 MAY Be REQUmm.
PLOT DIAGRAM '
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
SC-1cr 4
SME OF NU YORK
OUIJNIY OF .... !.... .. S
C,v i C .. `S e.r.3 s n..........................being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named,
lie 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 arid belief.; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
......... ........da of ...... :20 C50
n
Notary Publi .. .......... (0 ��G .
ElJIABETM A S' S .••• .. ..............
MWARY PUBLIC.State'of NewYwk (Signature of Appl i.. t)
No.01 ST8008173,SuffolkCou
Tenn ExpiM$Juns 8.k
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NOTESc •
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FEE _. -
NOTIFY W➢ EM'_DIP.- "',RTMAT
^.
765-180? ' PM FOR THE
FOLLONP^IG IP
1 FOU" .1i 'O REGUIREE
FOR PC' " IETE
2. ROUGH 1 i & PLUMBING
3. INSULAT'O'R
4. FINAL v -PUCTION MUS
BE CONAM --R C.O.
ALL CONGTR, N SHALL MEE'
THE RFO�- ` �-N1'S OF THE N K
STATE CONSIRUCTION R ENERC
CODES NOT RESPONSIBLE FO,
DESIGN OR CONSTRUCIWN ERRORS m
0
PLUMBER CERTIFICATION �;'.r;0 g'FANCY OR �
ON LE COT T, v CLaav
A
CERTIFICATE OF OCCUPANCY -SE la UNLAWFUL W
SOLDER USED IN WATER
ri
— - - SUPPLY SYSTEM CANNOT OUTCERTIFICATE C"
- EXCEED 2/10 oft% LEAD. Or 0,��CU�A�CY a 0
- o
3 a
-- - - --
- DO NOT PROCEED WITH ueDERWR CERTICATE
REQUIRED
a z a
FRAMING UNTIL SURVEY q
FOUNDATION LOCATION PLUMBING
. ALL PLUMBING WASTE
HAS BEEN APPROVED
&WATEq LINES NEED
TESTING BEFORE COVERING
P OVIDEARTI-SCALDANDAR
TI IERMAL SHOCK PREVENTING U copper tubing is used L
ICES AS TO PART.902.6(x% for water distributing
of types K or L only
N.Y. STATE BUILDING CODE. system; piping shall be
�
j I L L,
i UNDERWRITERS CERTIFICATE
I PROVIDE'/, NR. FIRE REQUIRED
I �� ISI RATED SEPARATION TO V
PART.717.3 (f)(1)OF
N.Y. STATE BUILDING CQ9 f. rc�y
tic°)o W
Y 'cEff''� S W
_ I W
LASTER S L'� ISE
a= ►� .y
�^ F06t
/u.}Y.,�❑� �r��cT [i�Yn-�4 .�X/ �� / 3Jl GJ
rT 3/iGK s,. 0
PROVIDE SMOKE-DETECTING PROVIDE OPENINGS FOR
ALARM DEVICES EMERGENCY ESCAPE AS
REQUIRED BY PART. 714 OF _ LL AS TO PART. 721,1 N.Y. STATE BUILDING CODE. o Op
u�
N.Y.S BUILDING CODE.
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