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Home My WebLink About27085-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29459 Date: 05/21/03 I~{IS CERTIFIES that the building ADDITION Location of Property: 1030 COUNTRY CLUB DR CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County T~x Map No. 473889 Section 109 Block 3 Lot 2.13 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 2, 2001 pursuant to which Building Permit No. 27085-Z dated FEBRUARY 26, 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 SUNROOM ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GERALYN J WIESER (OWNER) of the aforesaid building. SUFFOLK COUIF~YDEPARTMENT OF ~EALTHAPPROVAL N/A ELECTRICAL CERTIFICATE NO. 1112160 03/14/03 PLUMBERS CERTIFICATION DA'rED N/A ~/~S~ignat ute Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27085 Z Date FEBRUARY 26, 2001 Permission is hereby granted to: GERALYN J WIESER PO BOX 1143 CUTCHOGUE,NY 11935 for CONSTRUCTION OF A NEW SUNROOM ADDITION TO AN EXISTING SINGLE FA~4ILY DWELLING AS APPLIED FOR. at premises located at 1030 County Tax Map No. 473889 Section 109 pursuant to application dated JANUARY Building Inspector. COUNTRY CLUB DR CUTCHOGUE Block 0003 Lot No. 002.013 2, 2001 and approved by the Fee $ 75.00 Rev. 2/19/98 ORIGINAL Form No. 6 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 'l I 4 ' 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 fomg. 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 topogd'aphic 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, New Construction: ~ Old or Pre-existing Building: Location of Property: House No. / Street Owner or Owners of Property: Suffolk County Tax Map No 1000, Section /tO ~7 Block Subdivision eermitNo.~ ~ _~"~I~ateofmermit. ~/~,~/~/ Health Dept. Approval: 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 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Dat . Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~'~. (check one) Hamlet · ,~- Filed Map. Lot: _ Applicant: Underwriters Approval: Final Certificate: 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 JIM SAGE ELEC. INC. P.O. BOX 38 GREENPORT, NY 11944-0038, GERALDINE WEISLER 1030 COUNTRY CLUB DRIVE CUTCHOQUE, NY 11935 Located at 1030 COUNTRY CLUB DRIVE CUTCHOQUE, NY 11935 Application Number: 1112160 Certificate Number: 1112160 Section: Block: Lot: Building Permit: BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, Outside, 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 14th Name QTY Rate Wiring and Devices Receptacle 5 0 Switch 4 0 Fixture 7 0 Dinnners 4 0 Day of March, 2003. Rating Circuit Type General Purpose General Purpose Incandescent seal 1 of 1 lhis certificate may not be altered in any way and is validated only by the presence of a raised seal at tine location indicated, STATE OF NEW YORK ) ) SS.: COUNTY OF SUFFOLK ) ~N~ (~*'l, ~ I_~-T*L~ , being duly sworn, deposes and says: That deponent is over the age of 18 years, and resides at ~,Oo o~-~O-u~.~ ~J.~ r~,~X-~TITOC¢~- That on the 2.° day of ~, ~ . 1999, deponent, being the 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 C e (9 Nf~'~R). Architect/Engineer Sworn to be~re me this ~ day of '~-~ Notary Public cc: applicant 765-1802 BUILDING DEPT. INSPECTION [ ~'] FOUNDATION 15T [ I ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: '~ , / ,DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FIREPLACE & CHIMNEY REMARKS'~ DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] ~J*PLBG. [ ~'INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION ]FOUNDATION 1ST [ ] ROUGHPLBG. I FOUNDATION 2ND [ ] I~ATION ] FRAMING [~] FINAL I FIREPLACE & CHIM~NEY DATE INSPECTOR ROUGH FR/k~E & PLI~tBING FIELD INSPECTION REPORT DATE COI~4ENTS FOUNDATION (]ST) ~ ADDITIONAL COI~IENTS: TOWN HALL · SOUTHOLD, NY i'1971 TEL: 765-1802 Approved Disapproved ,20___ ,20___ Do you have or need the following, before applying , Board of Health 3 sets of Building Plans Survey_ Check Septic Form N.Y.S.D.EC. Trustees Contact: Mail to: - Building InspectOr~ APPLICATION FOR BUILDING PERMIT Phone: ~ hr71- ~g'qo Date 20 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 schbdule. b. Plot plan showing location of lot and of buildings qn premises, relationship to adjoining premises or public streets or ' areas, and waterwaysJj: c. The work ~overed by this application may not be commenced before issuance of Building Permit. d. Upon appro~,al 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 port for any purpose what-so-ever until a Certificate of Occupan is issued by the Buildi.'ng Inspector. APPLICATION IS HEREBY MADE to the Building. Department for the issuance of a Building Permit pursuant to the Building Zone Ordina.~ce of the Town of Southold, Suffolk County, New York, and otJac'~ appli, j.~ble Laws, Ordinances or Regulations, for the cpnstruction of buildings, additions, or alterations or for remov~or qler961it]on as heiein described. The applicant agrees to comply with all applicable laws, ordinances, building code, ho?~ing fore, a~d/~egul~ions, and to admit authorized inspectors 'bn premises and in building for necessary inspections. ~~_~,/~ - (~tgnt~r~,,-, of'applic~ant or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect,' engineer, general contractor, electrician, plumber or builder 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... Plumbers License No. Electricians License. No. 3a P '. Other Trade's License No. Location of lan~ on which proposed work will be done: House Number ' Street Hamlet r .... County Tax Map No. 1000 Section //~)7 : Block -- .5 ~ Lod,)3 Subdivision c'Ot~z/,c~o ~O/~,,~ ~'-~Zt~/t::$ Filed Map No ...... i' Lot "(Nan~e) . . i ' Nature of work (check which applicable): New Building. ' Repair Removal Demolition Estimated Cost .'~ ,,9~ Fee State existing use and occupancy of premises /. ~-~,,r~,'/~ ~li3':'. ~t'~'~_.~ . and intended use and occup~cy of p. roposed construction: a. Existing use and occupancy Addition I,~ Alteration Other Work (Description) (to be paid on filing this application) ;. If dwelling, number ofdwelling units Number of dwelling units on each floor If 9arage, number of cars ,. If business, commercial or mixed occupancy, speci~y,na~,u.i~and'e~xtant of each type of use. . Dimensions of existing structures, if any: Fror~t Rear's. Height Number of Stories Dimensions of same structure with alterations or additions: Front / Depth //4' / Height ~ Dimensions of entire new construction: Front Height Number of Stodos Number of Stories Rear .Depth / Rear / .Depth Size of lot: Front Rear .Depth 0. Date of Purchase Name of Former Owner 1. Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation: 3. Will lot be re-graded Will excesg fill be removed from premises: YES NO 4. Names of Owner of premises Name of Architect Name of Contractor Address. Phone No. Address Phone No Address Phone No. 5. Is this property within 100 feet of a tidal wetland? *YES NO · IF YES, SOUTHOLD TOWN TRUSTEES pERMITS MAY BE REQUIRED 6. Provide survey, to scale, with accurate foundation plan and distances to property lines. 7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: :OUNTY OF being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, ,3)He is the (Contractor, Agent, Corporate Officer, etc.) fsaid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; ~at all statements contained in this application are true to the best of his knowledge and belief; and that the work will be srformed in the manner set forth in the application filed therewith. worn to before me this ~tqd day of "~ ¢10.1~/'-~/ 20(~/ ~ - Not~ry Public ff CAROL A. MILLER Notary Public, State et New york No. 01 MI6003086 Qualified in Suffolk County Oomrnlssion Expires February 23, Signature ~f Appli'~t