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HomeMy WebLinkAbout27409-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28527 Date: 06/19/02 · ~{IS CERTIFIES that the building ALTERATION & ADDITION Location of Property: 300 WILSON RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County T~ Map No. 473889 Section 103 Block 4 Lot 44 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 20, 2001 pursuant to which Building Permit No. 27409-Z dated JUNE 18, 2001 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 OF GARAGE TO LIVING SPACE AND DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAY C & KATHRYN C BURKH3LRDT (OWNER) of the aforesaid building. SUFFOLK COUIFI~f DEPART~ENT OF ~%LT~APPROV~J~ N/A ELE~£KICAL CERTIFICATE NO. 1058530 06/12/02 PLUMBERS CERTIFICATION DA'£~ N/A /~or~ed S~gnature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28528 Date: 06/19/02 THIS CERTIFIES that the building ACCESSORY Location of Property: 300 WILSON RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 103 Block 4 Lot 44 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 20, 2001 pursuant to which Building Permit No. 27409-Z dated JTJNE 18, 2001 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 ACCESSORY ABOVE GROUND SWIMMING POOL AND ATTACHED DECK WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to JAY C & KATHRYN C BURKHARDT ( OWNER ) of the aforesaid building. SUFFOLK COUIqTYDEPARTMENT OF ~RALTHAPPROVAL ELB¢-I~ICAL C~TIFICATHNO. PL~q~BERS CERTIFICATION DA'i'~o N/A 1058530 06/12/0~ N/A +/~ S/ignature 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. 27409 Z Date JUNE 18, 2001 Permission is hereby granted to: JAY C BURKHARDT 300 WILSON ROAD CUTCHOGUE,NY 11935 for : ALTERATION OF GARAGE WITH WOOD DECK ADDITION AND AN ABOVE GROUND SWIMMING POOL TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR 2 CO'S REQ. at premises located at 300 County Tax Map No. 473889 Section 103 pursuant to application dated FEBRUARY Building Inspector. WILSON RD CUTCHOGUE Block 0004 Lot No. 044 20, 2001 and approved by the Fee $ 225.00 ~natUre ORIGINAL Rev. 2/19/98 Form No. 6 TOWN 01; SOUTHOLD BUILDING DEPARTMENT T O V,q'q HALL 765-1802 This application must be filled in by typewriter or ink and subnfitted to the Building Department ~vith th~'e folf)~ Ac For new building or new' use: 1. Final survey of property with accurate location of all buildings, property lines, streets, mid unusual natnral or topograptfic features. 2. Final Approval fi'om 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 iii system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, .multiple residences and similar buildings and installations, a certifical · of Code Compliance from arctfitect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses t. 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 Occupanc5 is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees . 1..~ertifieate 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 Cea'tificate of Occupancy on Pre-existiag Building - $100.00 3. Photocopy of Certificate of Occupancy - $ 0.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. Nc~w Construction: Location of Propca-ty: Old or Pre-existing Building. / (check one) House No. Street Og~ner or Owners of Property: '.~¥ Suffolk County Tax Map No 1000, Section I o ~, Block Subdivision ...~,o ~ ~ ~ ~40 ,~.L--~ Filed Map. Permit No. Health Dept. Approval: Lot: Dateofeennit. "~-1~,~-~ _Applicant: ~J'&~ _~ ~¥lqq~¥/k/~t/c~/~t-/ttr~l- ~'[ ~./~cC'~'~-50-/a/~'Underwriters Approval: .It I 2~ ~°1 Planning Board Approval: Request for: Temporary Certificate Fe'e ~ubmitted: $ .,~00 / Final Certificate: __ V' (check one) Applicant Signature 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 r~ JAY BURKHARDT JAY BURKHARDT ~ 300 WILSON ROAD 300 WILSON ROAD CUTCHOGUE N.Y. 11935 CUTCHOGUE, NY 11935 Located at 300 WILSON ROAD CUTCHOGUE, NY 11935 Application Number: 1058530 Certificate Number: 1058530 Section: 103 Block: 4 Lot: 44 Building Permit.'27409 Z BDC: NS11 Described as a ResidentJa! occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Outside, Pool/Spa, 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 12th Day of Ju~e, 2002. Name QTY Rate Rating Circuit Type Appliances and Accessories Pool/Spa Bonding 1 0 Wiring and Devices Receptacle ! 0 GFCI i Receptacle 1 0 20 amp Pool/Spa (Swimrmng Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. seal m-'l 1 of l This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ! 40 FULTON STREET, NEW YORK, NY 10038 ' - Application No. onfile "i'!?i~'?~}~l/t~[ H O73~22 THIS CERTIFIES THAT PERI{IT N©. ~7407 o~iy ~e e~c~al equ~ment as desc~bed below and introduced by the ~plicant named on the ~ove applica~on number ~ in the prem~es of 7A'F EURKHg~DT, 3~3 ~TILSON ROAD~ CUTCHO3UE, NY in ~e fonowing ~ca~n; ~ Basement ~ Ist Fl. ~ 2nd Fl. w~ *xamined on SEPT~*~R 2~ ~ 2~()i " - Section Block ~t and found to be in compl~nce with the Na~onal Ele~al Code. ~ I~cmAcm~ SWITCHES I , FIXTURES , r ~ANGES I COOKING DECKS OVENS DISHWASHEES EXHAUSTFA kMT. K.W. AMT. K.W. AMT. [.W. AMT. K.W. AMT. H.p.S ~. K.W. OIL H.P. GAS ~ H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. J TRANS. AMT. H.P. NO. OF FEET AM~. WA~ r ;EEVICE D SCONNECT NO. OF S E R V I PADD~ FAN-1 R/S CODE "B"-I 300 WILSON ROAD CUTCHOGUB, NY, 11935 llGENERAL MANAGER Per mull not be altered In any mgnn®r; return lo the office of the Board If incorrect, Inspectors may be Identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER TOWN OF SOUTHOLD PKOPERTY RECORD CARD OWNER FORMER OWNER N VILLAGE W DISTRICT SUB. ACREAGE ,/G,,,dd TYPE OF BUILDING RES. LAND AGE NEW Farm Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushl~n~d House Plot Total SEAS. IMP. NORMAL Acre VL TOTAL V FARM DATE BUILDING CONDITION BELOW Value Per Acre COMM. r,ND. CB. J MISC. Est. Mkt. Value ABOVE FRONTAGE ON WATER Value FRONTAGE ON ROAD BULKHEAD DOCK BUILDING PERMIT REVIEW CHECK LIST APPLICANT NAME: '-~ · ° o- //?~' x4Aa,,,,a 7- SCTM#--- DISTRICT: 1,000 SECTION: /009 BLOCK: STREET: .300 bo,/_.~..~ ,//o,~ CITY: PROJECT DESCRIPTION~~}~ N/O: t~ ~.,,3e ARCHITECT / ENGINEER: ~ DATE REVIEWED: ~' //~/01 DATE SUBMITTED:~_ /.~/01 4f LOT: ~ ~'},w ~,,y.~ SUBDIV. NAME: FAST TRACK: YES o~_..~ S1NGLE & SEPARATE CERTIFICATION-REQUIRED: YES OR NO NOTES: LOTS 40,000SF -100-24, Lot recognition.(CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN. 1997 100-25. Merger.(A nonconforming at any time after 7/1/83) ZONING: PERMIT ESTIMATE AMOUNT: $ .~/~' .00 PERMIT USE: EXISTING: C~',~_- INTENDED: ~ ZONING DISTRICT~, R80, AC, CONFORMING: YES OR~'REQUIRED LOT SIZE: 4or~ SQFT. WHERE ACTUAL LOT SIZE FROM?ynx c^m) ~,~ J-g ACTUAL LOT SIZE: ~-oaoa SQFT. REQUIRED a, ~ REQUIRED REQUIRED 1sx FOUND: FRONT:'~' PROPOSED: ~e] , SIDE YD: /~ '/....~' ' PROPOSED: ~ '/.~',,2. ' REAR: ~ ' PROPOSED.-~t~o' 2~D FOUND: FRONT: ' ACTUAL: ' SIDE YD: '/ ' ACTUAL: '/ ' REAR: ' ACTUAL: LOT COVERAGE: ~LOWED:~_% EXISTING:__4~-f__ % NEW' - s£ % TOTAL: sf % CORNER? YES o~"NO~ WAT ER FRONT? YES 0~? ~ESCRIPTIO~q: .... FLOOD COMPLIAN'CE ZONE: PRE-FIRM 3/18/80 PANE'E~: /~q~ FLOOD ZONE:/~ , AGENCY PERMITS REQUIRED FOR REVIEW INCLUDED IN APPEL TOWN SPETIC PERMIT: YES or~ SUFFOLK COUNTY HEALTH DEPT: YES or~' APP! NEW YORK STATE DEC: PRE-nrc 9/1/75. YES or~. SOUTHOLD TOWN TRUSTEES: YES or 1~ TOWN ZONING BOARD APPROVAL: YES or( TOWN PLAN. BOARD APPROVAL: YES or' TOWN HISTORICAL PRE (SPLIA): YES,oQ )- NYS ENERGY: YES OR NO : EGRESS: BUILDING PERMITS OPEN/EXPIR]~D: BP HAVE PRE CO'S: Y OR N BP NOTES: [~ATION (BED #):__ DTE: / / PERMIT #:RI0- DVALS REQUIRED: VENT: LIGHT: -Z / C/0 Z- -Z / C/0 Z- FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR : '~1~: SECOND FLR : SF TOTAL: ~ SF rOT( SF)- ( SF-- r- /Mo --------SF)= ~ SF X $ =$ INIT OTHER TOTAL FEE FEE FEE +$ +$ 7G5-~,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/~~LATION [ ~RAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS. ~~=.~~~___ DATE INSPECTOR FIELD INSPECTION REPORT - [! [! I1 FOUN~)ATION (ZST) FOUNDATION (2ND) II ~ · II J! COHI~NTS II/ ROUGtl FRAI.~ & ~i,~ Il Il II INSULATION PER N. Y. STA~ E~ CODE II II II II II II II II II I I 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT L_. i TOWN HALL '. $OUTHOLD, N.Y. 11971 [~_ ], ~ .... . TEL.: 765-1802 -I Examined ....... (~./..~.... ~/. Approved ....... ~/¢~¢ ....... ,~./.. Permit No ............ ,f-2'~:~ ~ Disapproved a/c ..................................... (Building Inspector) BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: INSTRUCTIONS $ 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 giving a detailed description of layout of properW must be drawn on the diagram which is part of this appli- cation. 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 issued 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. 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, o ~ ,. ~ (SignaL' 'ure of applicant,'i3;:n;~f a corp;ia~io'~) .... (Ma~ling address of applicant) State whether applicant is owner, lessee, agen.t, ~chitect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S MUST_BE SUFFO.[.K COUNTY LICENSED Builder's License No.. l~,.f .~ .~...~., .-~. ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done~ ............... ./>~ ............................... ::-:. ...... : ' ...... . ... House Number Street Hamlet County Tax Map No. ,000Section ../0.~. ......... Block ...,~,, ............ Lot..~...~. ........... Subdivision ..................................... Filed Map No. ' Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~./~. .' ........... ~!, .' .'~. '. ~ :..:.. ! ,:':, ] ~'~ ~ : ~i.'. ............ b. Intended use and occupancy ~c '-" ' -"': '~: ': ~:: ~ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition · · '. .... Alter'ation .... Repair .............. Removal .............. Demolition .............. Otfi&~ o o -- (Descrip io , 0 I 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 nat,ure and extent of eac~ type of use ..................... 7. Dimensions of existing structures, if any: Front..../-]'.(e ......... Rear ....~..4. ] ..... Depth .'3 ].'.-...Z:. ,~-.... Height f.~.t ............ Number of Stories . . ./.'~ ................. Dimensions'of sam.e_gstructure with alterations or additions: Front .... .~i~,i. i i i i i i i 'R~r'~ 8. Depth..,,~J..~..~ ............ Height .../. ~.' ................ Number of Stories... ,/.~.. .............. Dimensions of entire new construction: Front /.~. ( ....' ..... Rear .. f-r..~. ........ Depth ...z-r..~. ~ . Height . U ............. Number of Stories ...... ~..¥15~,y:~]. ~..tc.~.~.~./~.SU'O...-'~.~-~..:.. i i. 9. Size of lot: Front ...... /.c..'~ ....... Rear lf;~' Depth "~ c~ 10. DateofPurchase ............................. Nameg. f Former Owner .lf';g.-~'~:~LLg~- 11. Zone or use district in which premises are situated ~ /'(~.~.~ ~'rd' ''~ '''_ c/ ............ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~{/f~ ~.' ....................... 13. NW;flllot~be..regrade~ .......:,.:,._~?!~.:~.; .... .;.~..:.W,i.ll.e. xcessfill~beremovedfrompremises: Yes i4. _ ame o~ owner o~ premises 4~. ¥.q .~./~ .r~.~.~.~..llli($~¥~bK. J~f~/.5.~.~.. (~la. ~'~..//~one No ~. ~ ~f' ~ ~ Name of Architect , Addra~ ~ ...... ~h~o x~' ............ Name of Contractor ft/.~,,.~ ./,t:~. 5!. :. ............. Address~.."~...~. ~..oT.~.¢.~one,,No. ~'~.. ~: 15. Is this property loch'ted within 300 feet of a tidal wet~and? *Yes ~ .... 'N~...if .... : .... · If yes, Southold Town Trustees Permit maybe required. PLO'F DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~indicate all set-back dimensions from ~roperty hnes. Give' street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. ;TATE OF NEW YORK, ~OUNTY~ .... f...~.fT~.r~S'S ~? ......... '~..~' ~"~ - ............. being duly sworn, deposes and says that he is the applicant (Name of in~du[l~igning contract) toove named. (Contractor, agent, co,orate officer, etc.) ' ' ~f s~d owner or owne~, ~d is duly authored to perfom or have perfo~ed ~e said work and to m~e ~d file ~s .pphcation; that all statements contorted h this application are true to the best of his ~owledge and belief; and that ~e york will be perfomed in the m~ner set for~ ~ the application filed therewith. ;worn to before me this ......... ..... i ~ ~pi~ June 8] ~ ............ ~'' '/F ~; :' X .... ; ....... f · ~ ~ {~]~ature o~ app~c~t) Z ~'ir 9. ,BO / / L CENS _D:LANO surveY' Gi~EENII, O~T NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL-- H.S. .STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DI! SYSTEMS FOR THIS RESIDENCE WlL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. Is} _ APPLICANT SUFFOLK CO. uNTY- DEPT. OF HEAL SERVICES ~ FOR APPROVAL OF CONSTRUCTION ONLY DATE: ~ H. S. REF. NO:: ~:- ~C)-l~ APPROVED: SUFFOLK CO. TAX'MAP DESIGNATION: DIST. SECT- BLOCK PCL. OWNERS ADDRESS: DEED: L. ~'/"~.'~ TEST HOLE .p. STAMP -FO ~ A ~A[ID ~UE COPY. GU~R~ I~ CArD HE~ON SHA~ R~ SE~L "IMMEDIATELY' ENCLOSE POOL TO CODE UPON COMPLETIOH BEFORE 'WATER' 4. FINAL - CO.S'~UC?~O" MUST BE COMPLETE~R ALL CON&"~RUCTION {~l'~l,~l.l,,~ MEET THE RE~~S~~E N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE; DESIGN OR CONSTRUCTION ERP{~ PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS REQUIRED BY PART. 714 OF N.Y. STATE BUILDING CODE. OCCUPANCY OR UgE IS UNLAWFUL VVITHOUT CERTIFICATE OF OCCUPANCY UNI)EI6'VRITEI~ CERTIFICATE REI;)UIRED ii/.',' ~['~00 U~ .