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HomeMy WebLinkAbout27976-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29203 Date: 01/17/03 THIS CERTIFIES that the building ADDITION Location of Property: 2215 PINE TREE RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 98 Block 1 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 20, 2001 pursuant to which Building Permit No. 27976-Z dated DECEMBER 21, 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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EUGENE & ANN BURGER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1104204 12/31/02 PLUMBERS CERTIFICATION DATED 01/09/03 PETE VICTORIA '-')e /" /�" A riz Sign ure 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. 27976 Z Date DECEMBER 21, 2001 Permission is hereby granted to: EUGENE & ANN BURGER PO BOX 934 CUTCHOGUE,NY 11935 for ALTERATIONS AND ADDITIONS TO A SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 2215 PINE TREE RD CUTCHOGUE County Tax Map No. 473889 Section 098 Block 0001 Lot No. 014 pursuant to application dated DECEMBER 20, 2001 and approved by the Building Inspector. Fee $ 150 . 00 Authorized Signature ORIGINAL Rev. 2/19/98 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT 7 TOWN HALL 765-1802 . 1 APPLICATION FOR CERTIFICATE OF OCCUPANCY --22--i 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$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 Building- $100.00 3. Copy of Certificate of Occupancy-$25.00 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. / h6-) 3 New Construction: Old or Pre-existing Building: (check one) Location of Property: House No. Street Hamlet Owner or Owners of Property: ��Al �u/li N Suffolk County Tax Map No 1000, Section Block Subdivision / Filed Map. Lot: Permit No. 7i7�11� Date of Permit. 1�Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Aiplicant Signature TEL. 765.1802 �alrn �O��FFULII(CpGy TOWN Or SOUTHOM OITICE Or BUILDING INSPECTOR ;� P.O. BOX 728 = rn TOWN HALL �p • O� SOUTIIOLD, N.Y. 11971 C E R T I I' I C A T I O N Date I 6 Building Permit No. Owner -CGt��nJ�c (please print) print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) JUNE E.SAYRE worry PAk State of New Yak No.4948545 Svorn to before me this c ahsum coroa�sion 3 3 ------day of JCtJll �, ..��u3 7 )-4o Notary Public Notary Public, ����V� County 0 5 BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS SBUREAU OF ELECTRICITY S40 FULTON STREET — NEW YORK, NY 10038 5 5 CERTIFIES THAT 5 5 S 5 Upon the application of upon premises owned by S 5 5 G &S ELECTRICAL CONTR. EUGENE BURGER 5 BOX 215 2215 PINE TREE ROAD 5 SOUTHOLD, NY 11971, CUTCHOGUE, NY 11935 5 5 Located at 2215 PINE TREE ROAD CUTCHOGUE, NY 11935 5 5 Application Number: 1104204 Certificate Number: 1104204 5 Section: Block: Lot: Building Permit: BDC: NSI 1 5 Described as a Residential occupancy,wherein the premises electrical system consisting of 1 electrical devices and wiring,described below, located in/on the premises at: �J Basement,First Floor,Second Floor, 5 Swas inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was 5 found to be in compliance therewith on the 31st Day of December,2002. 5 Name OTY R gS R gfiU Circui _T�= Appliances and Accessories Oven 2 0 11.5 KW Exhaust Fan 2 0 F.H.P. 5 Dish Washer 1 0 1.2 KW 5 Disposal 2 0 F.H.P. 5 Panels 1 100 20 5 Wiring and Devices Receptacle 18 0 General Purpose rj Switch 17 0 General Purpose 5 Fixture 23 0 Incandescent 5 Dimmers 5 0 5 Receptacle 3 0 GFCI 5 5 seal 5 5 1 of 1 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 - 0 REYT'z�wT f` Applicant/ Date Owners Name: Reviewed: / O Architect/ Date Engineer: Submitted: SCTM : District: 1,000 Sectjon: 131ockl Lot: Project Subdivision Location: -�jJ �rn.c 75Name: Sin&Ie & separate Required certification: (Yes/No) Req, . Zoning Disvict: �� (IAl'SIZC: /T( Amial: . I (Lot coverage 6� ,rotxiscd L� Req. /tS� / r �/ [front Yard Proposed:— Req. Req. (Side Yard Proposed:_� 1 (Rear Yard _ Proposed-110 Project Description: , AGENRM TS Permit RE UIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. f New York State D. E. C.f - - " �^'�C Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: Notes• 0�/ //�J n 76z 765-1802 BUILDING DEPT. INSPECTION [ VI FOUNDATION IST [ ROUGH PLBG. [ �] FOUJdDAT10N 2ND [ ] INSULATION [ ]'FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMAR S: -76--- .0- ,,, 4z A IF 60, 101-1 A G DATE � O 2,-INSPECTOR BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL i [ ] FIREPLACE 8 CHIMNEY REMARKS: DATE INSPECTOR ass-isox suaoINc DE". INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 LAITION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY ` REMARKS: DATE ( l-`f d✓ —INSPECTOR—, ��M EIB M INSPECTION RRPORT '- DATE :�:•�� CObMENT3 77 ='" :�sasriao=tzaa='�=�=�asenee i'•t.' ftMA'TION ( 13T) DATION__ f 2ND) ROUGH FR.AM & - PLUMBING i WBUt AnON PER N. Y. ` ; 4- STAi'S 19MRGY con$. c FII�l1L .. P ApDIT14DUL co m Ms z . w TOWN OF SbtAc BUILDING PERMIT APPLICATION CHECKLIST BUILDING Du.. 1 �� �� Do you have or need the following,before applying? TOWN HALL :DE 01 I Board of HealthSOUTHOLD, 3 sets of Building Plans TEL: 765-180Survey FT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined 20 Of Contact: Approved ' ,200_t _ Mail to: Disapproved a/c Phone: BuildincrJm=w="= APPLICATION FOR BUILDING PERMIT Date I I "� , 20_QJ_ INSTRUCTIONS a- 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 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 a Certificate of Occupanc` is issued 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. Signaturef applicask or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee,agent, architect, engineer, general contractor, electrician, plumber or.builder 010 t./uL _ 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. (`{(v - t- Plumbers License No. Electricians License No. Other Trade's License No. 1- Location of land on which proposed work will be done: ����`{tri L, 22 ixS -P,,.� ire- � House Number Street Hamlet County Tax Map No. 1000 Section �1 00 Block Lot Subdivision. MASSA-U V L Uv_� Filed Map No. Lot (Name) 2. State existing use and.occupency of premises and intenod use and occupancy of proposed consttuctidn: a. Existing use and occupancy -TS o tN<<a L� b. Intended use and occupancy mor' 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost 00, UyCO 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. 2 7. Dimensions of existing structures,if any: Front Rear Depth JZ Height Number of Stories' Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase _Name of Former Ownery r V 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be re-graded N O Will excess fill be removed from premises: YES NO 14.Names of Owner of s ddress�-Z�S qi�In. b Phone No. - Name of Architect S _Address Phone No Name of Contractor Ad ss Phone No: 15. Is this property within 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES 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. 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, (S)He is the ( r/oi (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. Sworn to before me this n J day of Xl/e_r,e."j,d 20_p Notary Public Si tune of Applicant LINDA J.COOPER Notary Public,State of New York No.4P22563,Suffolk County Tcsr;;Ez„i;�s Uocemiser S'r,i$_��}� 1. Lat I�Q;5 VEFER TD MAG ()F_t'fA.�5AUf:A( 1v1��. FILEP EU ►N fZ�D�+�l p i20fAG. 1'NC UrF• CD.CLQ2IG'�_JFFF-'!CE AJ5 MAP NO- 1179. 2,SUFF. CD,TM MAP DATA; I J G198 f- 14. �_._. 3. FFLOQD ZONES PEf4I ' P-LaE RATE MAP, . �. Ft=oo0 ZONE_ B I _ FLOOD ZONE A.� it NtF BALL I AtJQ0.9 ,. a ,, - ,; ; - ;•,,�z..- - i 354.0 - - ----=�•'` - - E _ sy �j(�. 6 ''"•-�'^-�---_ 291.3 Qp,MP tt11 1 \ { WL;- STER1 X181 1 t. 6L�Q 41 2 SCC]RY El- t4OW 1MENT o` 'a to •'• _....-'_'` rTl�r _ _ _ '- _ _ _ _ _- - _ _ .. .. h^ er(_. [� _a_� �_.. � SILI �37Fi{F=IL (546 PEE-a D) ol S� (�.$'T"C74 2O .E � } ',!- '� _ MAE>t?NPY 1NAL� u 151f02Y l� 1 5� �9 It TC1.T! L1 NE „J �5 Do c - 1 d p,N 'b Q7 CON f✓� 35 S OIJC� ,`i.h�5 4�� ►1► 1 F .._.. ' ___. 294 U of n►Ew f 5.$7 Q 12Q•W. d Z\ FENCE ALONG LINE a - e \ i QEV15W 111- lG+� ''.. ts,wae ° I f'F BAU'-j JAND (F= l_ti'. .,1J(il'•! ,.1 t ENSTErG, ..1(L,� - 1 TtTi_tM• 1`40T5-:?o544 MAP OF P2,0 P E QT\' y' �+'S, S.!(2�.t 1,...Y 4�MF V(t7 --- �y� p edgy,,, copws of 1,L40t4owYoe, M GUARANTEED T0:FI.ATB 5�-( FEL?EfZAI. 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CERTIFICATE OF OCCUPANCY NOTIFY BUILDING D P M FOR TAT �I�r f, r-y K PLA � 7E5-1E07 E AM TO • PM FOR THE SOLDER USED IN WATER �"' �_- Lj J[1 FOLLOWINGINSPECTION& SUPPLY SYSTEM CANNOT t FOUNDATION • TWO REQUIRED I GI. II M 11 -01, FORPOUREDCONCRETE EXCEED 2/10 of 1% LEAD. DEG 2 0 2001 }' L ROUGH • FRAMING A FWMBING i INSULATION f, FINAL • CONSTRUCTION MUST �` I �� Q M_ ( ` � w 4:_ N F °FST ! BECOMKMFORCO� PROVIDE OPENINGS FOR Ucoppertubingisused L4 I `rrr�'a � '�iG/�i DA F = mno � S ALL CONSTRUCTION SHAH MEBT EMERGENCY ESCAPE AS for water distributing tEaeo quo A M U E L' S N p THE REQUIREMENTS OP THE NX REQUIRED BY PARL 714 OF system;piping shall be GI„I re H oem u liar. , fes{ ,�, �,°`° 0. 34h�rF S 7 E E L M A N �J'I1NI'I// STATE CONSTRUCTION II ENERGY of types K or L only �' �e•S M° CODES. NOT RESPONSIBLE FOR N.Y. STATE BUILDING CODE. 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