HomeMy WebLinkAbout27369-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUP~NCY
No: Z-29473
Date: 05/29/03
T~IS CERTIFIES that the building ADDITION AND ALTERATION
Location of Property: 1605 PINE TREE RD EXT CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
Cottnty Taxx )~ap No. 473889 Section 98 Block 1 Lot 7.7
Sutx~ivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 26, 2001 pursuant to which
Building Pez~it No. 27369-Z dated JUNE 8, 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 BATHROOM ADDITION AND ALTERATION TO A~ EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
T~e certificate is issued to V DENNIS & MARY JO WRYI~N
(OWNER)
of the aforesaid building.
~q3FFOLK CO~N~f DEPART~NT OF ~IF~kLT~{ APPROV~J~
HLRCT~IC3%L CERTIFIC~%~ NO.
PLUMBERS CERTIFICATION DA'r~ 05/21/03
N/A
115o3s 05/19/03
ARUS ANALYTICAL INC
~ ~//ho '/d~ignature
Rev. 1/81
FORM NO. 3
TOWN OP SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDINGPERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 27369 Z Date JUNE 8, 2001
Permission is hereby granted to:
V DENNIS & MARY JO WRYNN
CUTCHOGUE,NY 11935
for :
ADDITION OF A BATHROOM AND ALTER3~TION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR.
at premises located at
County Tax Map No. 473889 Section 098 Block
pursuant to application dated MARCH 26, 2001
Building Inspector.
1605 PINE TREE RD EXT
CUTCHOGUE
0001 Lot NO. 007.007
and approved by the
Fee $ 75.00
/~~utho~nature
ORIGINAL
Rev. 2/19/98
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 followiug:
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 for~n).
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:
i. Accurate survey of property showing all property lines, streets, building and unnsual natural or topographic
features.
2. A properly completed application and a consent t0 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
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
New Construction:
Location of Prope~'ty:
Old or Pre-existing Building:
t(check one)
gamlet
House No.
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision /L/~-e-~K tt~t~- ~--~..~/~'
Street
Block
Filed Map.
Lot
Lot:
Permit No. ~7,~b~
Health Dept. Approval:
Planning Board Approval:
DateofPermit. (.~/~/~)/ Applicant: ~
Underwriters Approval:
Request for: Temporary Certificate
Fee Submitted $ ,2 ~ --'
Final Certificate:
(check one)
ppl~caat Signature /
ARtJS Ana] yt:.ica.l ~
3].7 Bernice Drive 8ayport, New York 1.1705 (631) 472-4848
To:
!605 Pine Tree Road Extension Dar. e:
Cut. chogue NY 11935 Co]_]ected:O5/1/4~O:
(632) 451-4822 Received
e Co,pi. et ed: ~1/0:
Sample Taken By R..port._.d By:~
l..aboYat ory ~/~ -I
%amp].e : ~605 P~.ne Tr~e Road Ext. e~sion Sample Number~31.0~
Cut cNogue NY
Permit
Ne~ Bath/CoJd PJpe/SJ~k/9:OOam
Analysis : Lead Solder Scraping
Wrynn, Mr. Dennis Time Of L_ogin : 16:10:34
Parameters Results Paramet.ers Resul. t.s
~ ]ead ~ ]ead
~ lead In So]der 0.05
New York State Uniform
Fire Prevention & 81dg.
Code Sect. ion 9o5.5= Limit
For lead Content. In So]der
And Flux = 0.20~
Comments
Meet:~ N..Y.S. %fandard~
Peggy Parigoris Director of Laboratories
LONG ISLAND ELECTRICAL INSPECTION SERVICES, INC.
670 MIDDLE COUNTRY ROAD
ST. JAMES, NEW YORK 11780
(631) 265-3075
Fax (631) 265-6057
Application No.: 115038
Permit Number: 27369-Z
Block: Lot:
Section
Owner: Dennis Wrynn
Address: 1605 Pine Tree Rd.
Municipality: Cutchogue
OwnerPhone:
NY 11935
Agent: Dennis Wrynn
Address: 1605 Pine Tree Rd.
Cutchogue
License#: direct
Agent:
NY 11935
No. ITEM SIZE No. ITEM SIZE No. ITEM
9 Switches: 0 SubFeeds: 0 PoolsAbvBIo:
6 Receptacles: 0 Timers: 0 PoolslnGround:
1 GFCl Devices: 0 Transformers: 0 Pools Filter:
0 Dimmers: 0 ACEqulpmentCentral: 0 Pools Lights:
5 MedlumBaseFixtures: 0 ACEqulpmentWlndow 0 CO Detectors:
0 Fluroesce~ltFixt utes: 0 MotorsbyHP: 0 Disposal:
0 HID: 0 Generators: 0 Metal Halide Lamps:
0 RangeOvenCookTop: 0 WhirlpoolHotTub: 0 RsfrlgUnits:
I DryerElectric: 30 A 0 Microwave: 0 WalkinBox:
1 ExhaustFans: 0 WaterHeaterElectrlc: 0 ExhaustUnit:
1 CeilingFans: 0 SmokeDetectors: 0 SteamShower:
0 DW: 0 TrackUghtlngStrip: 0 BreadWarmers:
I Laundry: 0 ElectricHeat: 0 GarbageDIsp:
0 HeatlngEqulpMotors: 0 PumpMotor: 0 CentralVac:
0 ExitSIgns: 0 Disconnects: 0 ChandellerLIfts:
0 EmergencySIgns: 0 FutureOutlets: 0 ElevatorLIfts:
SIZE
LOCATION OF WORK: I~Basement [~FirstFIoor [] SecondFIoor [] Outside [] Addition [] Survey [] New Const.
Comments Existing Bedroom, Bathroom with Heatlamp, Hallway, & Walk-in Closet Renovation Inspection 5/21/03
/ Additions
~OH [] UG [] Amp:
Temporary []
Phase: 1_ Volts: Wire CU Conductor # of
Type: Size: Meters:
MemberI.A.E.I. Electrical Certificate Certificate No.
LONG ISLAND ELECTRICAL INSPECTION SERVICES, INC.
Certificate Issued on: 5/19/03
Issued to Dennis Wrynn
Address: 1605 Pine Tree Rd.
Cutchogue NY 11935
Dennis Wrynn
1605 Pine Tree Rd.
Cutchogue
NY 11935
115038
THIS CERTIFIES THAT OL
INSPECTOR CONDUCTEI
VISIBLE PORTION OF Tf
NADISTRICT
~.~LIE~c'T' I O N OF T HE
AND IS
TIONAL
IAEI Certified Inspector
BUILDING PERMIT REVIEW CHECK LIST
APPLICANT NAME:
DATE REVIEWED: ~r /~- /01
DATE SUBMITTED:~z~.~/01
SCTM#--- DISTRICT: 1,000 SECTION: ~}8- BLOCK: / LOT: -~.,>
STREET: /d6S' ,~0.~ '~e~.- ./'~o/ CITY: ~o, e.o~e SUBDW. NAME:~...~ ~
PROJECT DESCRIPTIO~LT, ACCoR N/Di~o~ fi/ ~/.~ ~ ff~Z ~ ~'
ARCHITECT / ENG~EER:~ ~<t~o o o FAST TRAC~NO
S~?0~0~0~-~4A~i~, ~~fJ2JTn;~0~~P~,~ 100-25. Merger.(A noneonfo=ing at any time a~ 7/11,1
PERMIT ESTIMATE AMOUNT:_$ ~/~ .00 PERMIT USE: EXISTING:
INTENDED:
ZONING:
ZONING DISTRICT: R40~__~AC,
WHERE ACTUAL LOT SIZE FROM.Vii~X~
REQUIRED REQUIRED
1sT FOUND: FRONT:'~) ' PROPOSED:/U~/~ ' SIDE YD: /o---~ '/3~-~ ' PROPOSED:
2~r) FOUND: FRONT: ACTUAL: ' SIDE YD: '/ ACTUAL:
LOT COVE...P~CkE: ALLOWED~% EXIST1NG:~:=~_~f % NEW: .st' _%
CORNER? Y ioR NO WAT ER FRONT? YES DESCRIPTION:
FLOOD COMPLIANCE ZONE: PRE-FImU 3/18/80 PANEL-"-~: /ff~ _ FLooD ZO~-E:~
CONFORMING: YES o~__) REQUIRED LOT SIZE:
SQFT.
ACTUAL LOT SIZE:--q~'fl9 SQFT.
REQUIRED
'/ · REAR~'O ' PROPOSED:/q~-
'/ --' REAR: ' ACTUAL: '
TOTAL: sf %
AGENCY PERMITS REQUIRED FOR REVIEW
INCLUDED IN A~TION
TOWN SPETIC PERMIT: YES o
SUFFOLK COUNTY HEALTH DEPT: YES or~.~[BED #): DTE: / / PERMIT #:RI0-
APPR/)VALS REOUIRED:
NEW YORK STATE DEC: PRE-DEC~/1/7$ YES
SOUTHOLD TOWN TRUSTEES: YES oJ~l~
TOWN ZONING BOARD APPROVAL: YES o~
TOWN PLAN. BOARD APPROVAL: YES o~
TOWN HISTORICAL PRE (SPLIA): YES
NYS ENERGY: YES O~'~ ./"~GRESS: VENT: LIGHT: ~.'--
BUILDiNG PE.R, MITS O~1~IR~JT-BP7-_ ...... =~T-~Z77CVOZ:~-- .... ~- --
HAVE PRE CO S: Y OP,/._N~ BP -Z / C/0 Z- .5e'e ./'ZC-."~-
NOTES: "
FEE STRUCTURE:
FOUNDATION: SF
FIRST FLOOR : 3~ SF
SECOND FLR : SF iNIT OTHER TOTAL
TOTAL: B~' SF FEE FEE FEE
rOT( SF)- ( SF)= SF X $__=$ +$ __ +$ = $ ~ ~
STATE OF NEW YORK )
) SS:
COUNTY OF SUFFOLK )
, being duly sworn, deposes and says:
That deponent is over the age of 18 years and resides at
That on the '~ day of A".¢ \ .2001 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 properly
located at SCTM# 1000- ~ ~ I - 7. ? ,
street address
1605 Pine Tree Road, Cutchogue, NY 11935
S~/%n to before me this
ay of ¢'IbcU, ,2001.
cc: Applicant
765-1802
BUILDING DEPT.
[ ] FOUNDATION 1ST
INSPECTION
[ ] FOUNDATION 2ND
[~MING
[ ] FIREPLACE & CHIMNEY
[ ] INSULATION
[ ] FINAL
DATE
INSPECTOR
765..1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 15T [ R~~OUGH PLBG.
[ ]/~NDATION 2ND [ ] INSULATION
[ '/1 FRAMING
[ ] FINAL
[ ] F,REPLACE & C.,MN~ ~
REMARKS: ~~~o~~_
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
] FOUNDATION 1ST [ ] ROU/_..GH PLBG.
] FOUNDATION 2ND [ ~ INSULATION
]FRAMING [ ]FINAL
[ ] FIREPLACE & CHIMNEY
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]/~SULATION
/
[ ] FRAMING [~/] FINAL
[ ] FIREPLA~.~ & CHIMNEY
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION 2ND
FRAMING
[ ] ROUGH PLBG.
[ ] INSULATION
FINAL
] FIREPLACE & CHIMNEY
REMARKS:
DATE
INSPECTOR _.~/~
~ELD INSPgCTION REPORT
FOUNDATION (IST)
~oUNDATIO~ (2ND)
DATE
ROUGH FRANE &
PLUI~BING
IR$OLATION PER N. Y.
STATE ENERGY
CODE
ADDITIONAL COl, fl, ill, frs:
Exam/ned ~'/.e~ ,200/_
Approved ~7/~ ,20 O/
Disapproved a/c
Do you have or need the following, before appiy
No. ? 73 ?-
Board of. Health
3 sets of Building Plans
Survey
Check
Septic Form
N.Y.S.D.E~C.
Trustees
Contact:
Building Inspector
APPLICATION FOR BUILDING PER.MIT
INSTRUCTIONS
Date
a. This application MUST be completely filled in by tYPewriter or in ink and submitted to the Building Inspector
sets of plans, accurate plot plan to scale. Fee according to sct/edule.
b. Plot plan showing location of lot and of buildings ~n'premises, relationship to adjoining premises or public stre~
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 Im'pector will issue a Building Permit to the applicant. Such a
shall be kept on the premises available for inspection througho.ut'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
is issued by the Building Inspector.
] APPLICATION IS HEREBY MADE to the Buildi3~g Department for the issuance of a Building Permit pursuan!
Bt~ilding Zone Ordinance of the Town of Southold, Suffolk Co(tory, New York, and other applicable Laws, Ordinances or
P-~gulations, for the cbnstruction of buildings, additions, or:alterations Or for removal or demolition as herein described. T
applicant agrees to comply with all applicable laws, ordinanies, building code, housing code, and regulations, and to admi
authorized inspectors on pr~mises and in building for neces. Sdry inspections·
.. (Signature of applicant or ~ame, ifa corpora~
·" (Mailing address of applica~)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or be
Name of owner ofp;remises L/, ~,~fiJtd'l,5 c~. ~t.~7 ~ /.~p.~x/r0/~r
(as on the tax roll or latest deed)
If applipant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders LicenseNo.
Plumbers LicenseN~.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will~:~e done:
House Number Street '
County Tax Map No. 1000 Section
S u b divi s/o n ~/~./tel- ~q_ff'~F~6 :~,r9.5
(Name)
BloCk /
Filed Map No._
Hamlet
-7. 7
Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b, Intended use and occupancy ~dd ~-{.~
Nature of work (check which applicable): New Building.
Repair Removal Demolition
estimated Cost ,-¢. 0/;
If dwelling, number of dwelling units /
If garage, number of cars ~
Fee
Addition
Other Work
Alteration
(Description)
(to be paid on filing this application)
Number of dwelling units on each floor
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of cxisdng structures, if any: Front ~, ¢'~r Rear,,, ~,.~t' Depth
Height Number of Stories 112--
Dimensions of same structure with alterations or additions: Front /,¢,~r Rear
Depth.__ ~y-~ ' ~ ~ Height. Number of Stories [
Dimensions of entire new construction: Front ~;"/~9 Rear ftc'd) Depth
Height Number of Stories /
Size orlot: F ont / Depth
Da,e oFPurchase ~/¢/¢ ~ Name of Foyer Owner
Zone or use district in which premises are situated
Does proposed construction violate any zoning law, ordinance or regulation:
¢¢Jll lot be re-graded ~ Will excess fill be removed from premise~: YES
4ames of Owner or Eremises ~ ~ Ad&ess, I P ghone No. ~B/
4amc of~chitect /~,'~ ~~ Ad.ess ~ ~g)1 ~ff~6;$ ~hone No
lame of Contractor -~,'/ ~ Ad.ess &3 ~'e~a ~, ~¢ Phone No. ~¢/
,'this property withih'/100 feet of a tidal wetl~d? *YES ~;~ //¢¢NO7
· W YES, SOUTHOLD TO~ TRUSTEES PE~ITS MAY BE ~QU~D
ovide survey, to scale, with accurate foundation plan and distances to property lines.
:levation at any point on property is at 10 feet or below, must provide topographical data on survey.
i OF NEW YORK)
tree of individual sil~ning conrrac )
being duly swom, deposes and says that (s)he is the applicant
above named,
(Con.actor, Agent, Corporate Officer, etc.)
wner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
atements contained in this application are true to the best of his knowledge and belief; and that the work will be
:t in the manner set forth in the application filed therewith.
before me this
__ day of. ~¢-~C~' 20 o /
Notary Public
Signature of Apphtcant
Marie 8asileo
NOTARY POBLIC of NewYork
No.4721687
Qualified in Suffotk Gourlty
;ommlall~n Expires April 30, 2002