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Home My WebLink About33427-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33326 Date: 10/08/08 THIS CERTIFIES that the building ACCESSORY Location of Prc~erty: 3965 GRAND AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 1 Lot 2.6 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 18, 2007 pursuant to which Building Permit No. 33427-Z dated SEPTEMBER 27, 2007 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 IN GROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. · ~ne certificate is issued to BRUCE D & LEIGH AN/q BERGEN (OWNER) of the aforesaid building. SIIFFOLKC~)I~i"ffDBPARTT~TT OF }~ALTHAP~O~L~L N/A E~t-rKICJkL C~ERTIFICAT]E NO. 7894 12/15/07 PLL~ERS CERTIFICATION DATED N/A Authorized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1801 APPLICATION FOR CERTIFICATE OF OCCUPANCY L This application must be tilled in by typewriter or ink and submitted to the Building Departm&~_[._w.~t__h.,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 ar topographic features. 2. Final Approval frmn Health Dept. of water supply and sewerage-disposal (S-9 finn0. 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 sirailar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Plamfing Board Approval of'completed site plan requiremeuts. B. For existing buildiugs (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate sm-vey of property showing all property lines, streets, buildiug and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. Ifa Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefbr 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 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. / off/fro ,,o New Constmct'o a: ~,~ t._ - Old or Pre-existing Building: LocationofProperty: 3~6-s- F~,;~,,,,.~ txl,.~t. (/Po House No. XStreet (check one) Hamlet Block Lot ~ Filed Map. Lot: _ Applicant: ,ff~... ,-,,. /d'~:~ & Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Permit No. 3~1',;17& Date of Permit._ ff//~/o ? ttealth Dept. Approval: Underwriters Approval: (check one) Applicant Signature Planning Board Approval: Request for: Telnporary Certificate Fee Submitted: $ Fiual Certificate: + SUE: 0 K BUR~AU=i~ 40 Nottingham Drive, Middle Island, NY 11953 Telephone: 631 495 8136 · Fax: 631 980 6455 · E-Mail: SBEIGS@gmail.com CERTIFICATE OF ELECTRICAL COMPLIANCE Applicant: Rough In Inspection Date: Application No.: Suffolk County Tax Map No.: Raymond Electrical December 15,2007 7894 Certificate No.: 7894 Final Inspection Date: December 15,2007 Building Permit No.: na 1000 104.00 01.00 002.600 This Certificate of ~:lectrical Compliance is limited to the inspection and compliance of electrical equipment and/or work described below, installed by the applicant named above, located at the premise of and not after the final inspection date above: Owner: Bruce and Leigh Bergen Site Location: 3965 Grand Ave.~ PO Box 1575, Mattituck, NY 11952 Owner's Address (if different): Residential Commemial New Addition Single Phase Three Phase Main Panel Sub Panel Transformer GFCl Breaker [] Indoor [~] Basement [] Service [] Shed [] Outdoor [_] First Floor [] Pool [] Hottub [~] ,R?novation ~ Second Floor ~ Attic ~ Garage ~ Survey Other: ' INVENTORY Heat 1-gas Duplex Recpt Ceiling Fixture HID Fixtures Hot Water GFCI Recpt 1 Wall Fixture Smoke AC Cond Single Recpt 1 Recessed Fixture CO Detect AC Blower Range Recpt Flourescent Pumps 1 Appliances Dryer Recpt Emergency Time Clock 1 Switches 1 Twist Lock Exit Fixtures TVSS Heat Pump Electric Heat Pool Luminaire 1 Exhaust Fan The electrical work and/or equipment described above were inspected and appear to be in compliance with local, state and national electrical code requirements and this office. Applicant: Raymond Electrical Inspected By: Gene Surdi Signature: License No.: 514iME Date Of Certificate: Jan 09,2008 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 33427 Z Date SEPTEMBER 27, 2007 Permission is hereby granted to: BRUCE D BERGEN PO BOX 1575 MATTITUCK,NY 11952 for : CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR at premises located at 3965 GRAND AVE MATTITUCK County Tax Nap NO. 473889 Section 107 Block 0001 Lot No. 002.006 pursuant to application dated SEPTEMBER 18, 2007 and approved by the Building Inspector to expire on MARCH 27, 2009/ -~ Fee S 250.00 ~ ~ ~SL~rize Rev. 5/8/02 ORIGINAL TOWN OF SOUTHOLD BUILDING DEPAI~TMEI~T TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined Approved Disapproved a/c ,20 Expiration 20__ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Plarming Board approval. Survey_ Check Septic Form N.Y.S.D.E.C. Trustees C ~ Contact: ~'~ ~ ~ Mail to:eChO ~ f'(x ~--.1~OX Building Insp&tor~ ~, APPLICATION FOR BUILDING PERMIT , ~, Date , , ~._.3 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 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 the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora 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_~./~ }(Signature of applicant or na , if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~fLl~ (~-~gcq '* ~.LI~ ~(0~ (As on the tax rolYor 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. Other Trade's License Location of land on.~whieh pro. posed work will be done: House Number Street County Tax Map No. 1000 Section Subdivision i0 q (Name) Hamlet Block i5 \ Lot Filed Map No. Lot State existing use and occupancy of premises and int~}ded use and occupancy of proposed construction: a. Existing use and occupancy ~-~Od¢~m'; lu ('/,.~dOlt4~ b. Intended use and occupancy irL~tll) iOdioar/~ 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition Estimated Cost~/5', ~ ~ Fee Addition Alteration Other Work If dwelling, number of dwelling units If garage, number of cars (Deschption) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front 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 Rear 10. Date of Purchase Name of Former Owner 1 I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO / 13. Will lot be re-graded? YES b~O__ Will excess fill be removed from premises? YES__ NO __ 14. Names of Owner of premises f~( cl~J ~:,8(0g(1 Name of Architect ~¢4.,O d e,_~n,,,r%o~ '" Name of Contractor <nnt~ I ~..Od/2-Ee~F 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES __ NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. Address Address NO 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 ) r~- ~J~ttrl,'~ q '7 ~'~D(t ~ (-~--t"- being duly sworn, deposes and says that (s)he is the applicant (Name Of individual signing contract) above named, (S)He 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 tree 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. '~ignature of Applicant TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION FRAMING / STRAPPING ~ FINAL ~ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~>~rflN ~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION 1ST [ ]ROUGH PLBG. ]FOUNDATION 2ND [ ]INSULATION FRAMING / STRAPPING [~FINAL /~ ~ i ] [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~'~ ~ ~ INSPECTOR ~' ~ Vm~D e~s~,~cnoN R~pORr I D~T~ I CO--rS ~ FO~ATION (1ST) ~ ~o~T~O~ (~) ~ ~S~ATION PER N.Y. ~- ~ STATE E~RGY CODE ~D~ION~ COUNTS ~ m 107-1-2.6 10/01 Jo COLOR TRIM Z~7~ ~o= ,~10\ ~c M. Bldg. / ~ ~ ~ JS~ Foundation FULL p~ Bath Dinette Extension Z~ Il - ~o) I~OO ~o Basement c,,w~ F~II Floors Kit. SLAB /~ 7 = loc / Extension 3 ~ lo ~ 3 ~ / Ext. Walls ~w4~ Interior Finish ~f~ L.R. Extension ~/i/ = ~ ~ Fire Place ~¢S Heat ~ ~ L ~ ~. D.~. Patio Woodstove ~orch ~I 5= ~8 Dormer Fin. B. 7~1~ ~o~ ~ Deck ~,~ ~5~ ~05 .~0 ~o~ Attic Br~zeway Rooms 1st Floor Garage ., Driveway Rooms 2nd Floor O.B. OWNER LAND IMP. ~TREET TYPE OF BLD. TOTAL DATE REMARKS ~oldo, ~ /~.1o ~ FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD TILLABLE WOODLAND MEADOWLAND HOUSE/LOT TOTAL 05-38-800? Og:SG SOUTHOLD BUILDING OEPT 1G31?GSg50B Yes EXEM~IONS: A. Does th/s project meet the m nimum standards for classification as an Agricultural Project. ,,/~ Note: If you answsrad~¥u to any,of the above, a $torm-water, Grading, Drainage & Erosion Control Plan Is not required. NO ACTIONS REOU~ ~]~NG THE: SUBMISSION OF A STORM-WATER. GRADING. DRAINAGE &.,EROSION CONTROL PLAN, OERTIF :tED BY'A DESIGN PROFESSIONAL IN THE STATE OF NE~V yQRg ~NJL~ (A Check Mark (J) for each question is required tbr complete application) 1. Yes No Will fltis projac! retain all Storm-Water Run-off generated on Site? (This will include all run-offcrcaWd by site. clcar/ng and/or construction activities, as well ~ all Sit~ Impmv~rnents and the permanent creation of imperv/ous surfho~s.) Will this projaot requuc any land filling, grading or excavation whcre them is a change to the natural existing grade involving more than 200 cubic yards of material within any parcel? Will this application require lamt disturbing aerie/ties encompa.asing an area of five thousand ($,000) square fi~et of ground surface or mm'e? ls thio a Natural Water oours¢ running through the site or is this projeot within One handled (100) fl:ct of wetlands or a beach? Will there be site preparation on slopes which exceed fifteen (15) fe~ of vertical rise to One hundred (100) fcct o£ horiz~utal distance? 6, Will driveways, parking areas or other impcrv/oua surfaces direct Storm-Water Run-off hate and/or in the direction of a Town Pdght-of-Way? r~ 7. Will this application require the placement of material, removal of vegetation and/or the .construct/on of any item with/n the Town R/ght-of-Way or road shoulder area? (This ffem does not include the installation of driveway aprons.) 8, Will there I~ ~it~ prcpan~timi'within the one hundred (100) year floodplain of any watercourse'/ I/ote: If,~l!y'an~ver to qu~tlons~one through elgM Is answered with a check mark In the Box, a Storm.water Oradin B;ainagd& EI;o$1on Control Plan ia required and must be submitted Ior review prior to Issuance of any building'permit. (Name of ind/vidual signing :fia~d-tlmt ltdSh~ is thc dOX~a_c-q-~ ~O~m,,-r and/or representative of thc Owner or Owner's, and J$ duly al:thorjzed to perform or have perfon'r~d th~ said work and to make ~and file this application; that all ststetnents ~ontaincd in this application arc truc to thc best of his kmowledge and belier' and that the work sill be performed in the manner act lb:th in thc application filed herewith. 8worn t/> before me tlfis; (Signature of ^pplkant) KATHLEEN ~UIGLEY NOTARY PUBLIC. State of New Yl~k No. 01QU6;2412.4 Qualified in ~ ~ J 0 0 STEPS OPTIONAL SLOPE o PLAN ALL CONSTRUCTION SHALL ,MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. ~SEE SECTION B-B SIZE FEET 16'x 32' 52 16' ~. 56' 116 13,6 20'x 40' 20 I 40 GRADE "IMMEDiATEL-y/L SECTION A-A C D E ! F G 512 [ ~B~)O0 576 B FEE: NOTI BUILDING AT .~ z::.'..~'" 765-1802 8AM TO 4PM FOR THE ~., FOLLOWING INSPEC IONS: 1. FOUNDATION -' REQUIRED FOR POURED ICRETE 2. ROUGH - FRAMJN( & PLUMBING 3. INSULATION 4. FINAL - CONSTR~ TION MUST BE COMPLETE C.O. ALL CONSTRUCTk MEET THE REQUIREMENTS YORK STATE. NOT DESIGN OR TYPICAL S E CTtO N VINYL ~.'. ~.' SAND--~ IOF' ,' SECTION MAX P LAN -.TY PICA L BARS RETURNS'~ X~TO FILTER SKIMMERSILTE Rond PUMP TO RETURNS / FROM FILTER PIPING ARRANGEMENT 350Otb POURED CONCRETE UNDERWRITERS CERTIFIOATi REQUIRED WALL FIBERGLASS MOULDED I PIECE OPTIONAL STEP TYPE I, ...,, ?...~%~ ~~~ sTE~S I OPTIONAL STEP TYPE NOTES. PROPOSED POOL FOR: CONTRACTOR RANDY T. RODECKER, SWIM KING POOLS ROUTE 2SA ROCKY POINT, INC. NY 11778