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Home My WebLink About36008-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34719 Rte: 12/02/10 THIS ~TIFIES ~h~t the building ALTERATIONS I~)cation of l~ro~rty: 805 GOOSE CREEK LA SOUTHOLD (HOUSE NO.) (STREET) (H/~4LET) County Tax Map NO. 473889 Section 79 Block 2 Lot 1 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in t~s office dated NOVEMBER 4, 2010 pur~,~-t to ~ch ~il~4-g Per.it No. 36008-Z dated NOVEMBER 8~ 2010 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 FOR BATHROOM IN BASEMBNT ~ BATHROOM ALTERATION ON FIRST FLOOR AS APPLIED FOR "AS BUILT." The certificate is issued to LAWRENCE J CULLEN TRUST (OWNER) of the aforesaid building. ~uF~OLKCO~TY~EPART~TOFHEALTHAPPHO%-AL N/A ~.~-~'lt.ICAL ~TIFICATENO. 36008 11/19/10 PLU~EP~ t%~KTIFICATI(~ D~r~u 12/01/10 CUTCHOGUE EAST REALTY 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) P~IT NO. 36008 Z Date NOVEMBER 8, 2010 Permission is hereby granted to: MILDRED B CULLEN PO BOX 1569 SOUTHOLD,NY 11971 for : "AS BUILT" BATHROOM (2) ALTERATIONS AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 079 pursuant to application dated NOVEMBER Building Inspector to expire on MAY 805 GOOSE CREEK LA SOUTHOLD Block 0002 Lot No. 001 4, 2010 and approved by the 8, 2012. Fee $ 400.00 Authorized Signature Rev. 5/8/02 ORIGINAL Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~¥1~ 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 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 usea, or buildings and "pre-existing" land uses: 1. Accurate survey of propet~y showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and co~sent 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 $50.00, Additions to dwelling $50.00, Altemtiona to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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 New Construction: l.,ocation of Property: House No. Owner or' Owners of Property: Date. Old or Pre-existing Building: Street Block Suffolk County Tax Map No 1000, Section Subdivision DateofPermit. ~l-~- I0 PermitNo. 3~ t~ Filed Map. Applicant: Underwriters Approval: Final Certificate: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~'~ · trO/.,~,j /[-oq- I0 (check one) Hamlet (check one) "~ ~ Applicant Si~mature Town H~I A~mex 54375 Mai~ Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 ro.qer, richert~,town.southold, ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Mildred Cullen ~,ddress: 805 Goose Creek Lane City: southold St: NY Zip: 11971 Building Permit #: 36008 Section: 79 Block: 2 Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: License No: SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Sen~iceOnly ~ Commedcel Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ Service 3 ph Hot Water GFCl Recpt Main Panel AJC Condenser Single Recpt Sub Panel A/C Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: 1 exhaust fan Ceiling Fixtures [~ HID Fixtures Wall Fixtures ~ Smoke Detectors Recessed Fixtures [~ CO Detectors Fluorescent Fixture ~ Pumps Emergency Fixtures[~ Time Clocks Exit Fixtures ~ TVSS Notes: as built bathrooms, one in basement, shower added on first floor Inspector Signature: Date: Nov 19 2010 81-Cart Electrical Compliance Form Town Hall Annex 5437~; Main Road P.O. Box 1179 · .~lhold, New York ! 1971-0959 Building P~mlt No. 3 Iv 6 ~3 ~' le.n Plumbec. BUI~DIHO DEPAR~ TOWI~ OF SOUTHOLD CERTIFICATION Date: (Please pr/at) (Please print) Fan (63D, 76~95D2 ' ,L:____'. . ~our~ioto I eettifT that tho solde~ used ia.tho water supply, systom eonta~ less than 2/I 0 tff 1% Notary Public, 511,~IIL. County PENNY BEDELL ~o~ry pubL~S,.-t~w ¥or~ No ul=E609931/ Qualif~l n Suffolk Coun'4 -~ ,. Commission EXp res Sept. 29, c.~ VI INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE&CHIMNEY [ ] FIRESA,-,~,T'INSPECTK~ [ ]FI#EIIESlS'r~n'CO~STmJCTI0. [ ]FII~IIESiS'rAm'I~NETRATION REMARKS: iNSPECTOR ~"~~ TOWN OF $OUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING / STRAPPING [ ] FINAL FIRF. FLACE & CNIMNEY [ ] FIRE SJIJ=ETY INSFECTICN ]FI~AESlSTJUrr~ [ ]FI~I~SlSTdU~rI'~IL=11~TION ELECTRICAL IROUGHI ~J~=, r-rTRICAL IflNAL) REMARKS: DATE TOWN OF SOUTHOLD ~BUIL~ING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined / //k' , 20{ 0 /- Approved / [/~_20 /0 Disapproved a/c Expiration ~'~/~, 20 ;t ~ PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey. Check Septic Form N.Y.S.D.E.C. Tmstees Flood Permit Storm-Water Assessment Form Contact: Building Inspector Phone: APPLICATION FOR BUILDING PERMIT Date tO- IS- ,20/0 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 pc?ail for an addition six months. Thereatter, a new permit shall be required. 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 inspectom on premises and in building for necessary inspections. (Signature of applicant or name, ifa corporation) ~.o.e~oT, I~bcl. Sou-I'hold, Iq"] IIC/-/i (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises O3,'ldted l~.Oul{00 ,od,',tedualI¥ aod a~ ¢o~Trua,~o.. a,td ~Ob~r+ L, ~uIK°a ~ ¢o-~f'ru$*e~} o'~ ~ (As on the tax roll or latest deed) L{l~oroaeo,.T, Cull{a Ifapplic~t is a ~oration, silage of duly au~ofized offic~ ~es~a~ ~cus~ ~[~ ~& (Nme ~d title of ~orate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: g 05 Ooose Oc e {¢ L a House Number Street Hamlet County Tax Map No. 1000 Section ,-].c~ Subdivision Block c9-. Lot Fil .ed~l~'No!:~" '~ Lot I 2. State existing use and occupancy of premiseS'and intended.use and occupancy of proposed constmcti°n: a. Existing use and occupancy ~'O~(t qeom)lu~ t?l~ot, lhn o~ I b. Intendeduseandoccupancy .5~rtO{.o. ~Oim,txI 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work O 5 bu,', Jr · ¢On~Orq', .t-o;i.e~c and ~ho~;~,- ~o bt~:~men~r OnA add,-h,~ O~ .~loo~o,c- -'re (Description) Estimated Cost @xts~,n9 hal~c ~-I-In Fee ~ t t t 0n a4, u ¢ 4, o ~, ~p?'~ ~ e' ~'o ~F- I :2-- l q Got- (To be paid on filing this application) If dwelling, number of dwelling units I Number of dwelling units on each floor f' ~ ~ c to - I If garage, number of cars 6. If business, commercial or mixed Occupancy, specify nature and extent of each type of use. g) / o~ 7. Dimensions of existing structures, if any: Front ~ ~ ~ i~ear ¢1 ~ ' Depth ~ Height It)t- ~ Number of Stories . I Dimensions of same structure with alterations or additions: Front H~ Rear Depth' ~> ~ ~ Height I~ ~ Number of Stories I 8. Dimensions of entire new constmenon: Front Rear .Depth H~i0ht Number of Stories 9. Size oflot: Front }~Ot Rear ~c~ ~ Depth Oc['~ ~ & ~,c-~I 11. Zone or use district in which premises are situated P~ Q~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO ~x 13. Will lot be re-graded? YES NO X Will excess fill be removed fi.om premises? YES NO 14. Names of Owner of premisesil0' Id ced Name of Architect Name of Con~'actor 0 [ n '.._ P. 0.&ox 1~6cl" PhoneNo. AQoress . : " '~ - Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a fi.eshwater 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. NO × 16. Provide survey, to ~cale, 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. 18. Are there any covenants and restrictions with respect to this property?. * YES__ · IF YES, PROVIDE A COPY. NO X STATE OF NEW YORK) SS: corn, trY OF &vF . o ), DO, Id £~ C{ ~>- ~ IJ J Iq ~k) being duly sworn, deposes and says that (s)he is the applicant (Name of individual mgnmg contract) above named, (S)He is the 0 03 0 ¢ r (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 me 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. ~ r~omry ruo.c ~otspt Publio, State d NewYork No. 02GOSO24~40-Suffolk Ce~t'L Commissioa Elifir~ ~ 14, 20_.~ Signaffu'e of Applicant ~-,ab-.__~_ eeeviy~ . . . v ~ wlm~ One Hundred (10¢) feet ~ a W,~amf ~r wh~h ~ceed F'~een (~a) fee~ of Ve~;~ R~e ~o · ! I: X k4o md/er la Ibe d~molk~ ~r a Tovm ~.qmy? FORM - 06/10 JENNIFER B. GOULD Notary Public, State of New York No. 02GOSO24640-Suffolk Count~ Commission Expires March 14, REQUESTED BY: Company Name: ~lame: License No,: Phone No.: ~ D~T TOWN OF 80UTHO~ APP.LICATION FOR ELECTRICAL INSPECTION· JOBSI:TE INFORMATION: · *Cross Street: *~ne No.: (*fndi~tes required information) ~cc'¢c-o 'e., u cce¢' *BRIEF DESCRIPTION OF V~)RK (Please Print. Cleady) L~c o( .(pm Cfrde AJJ'nut .AMy) ready for inspeo.on: *'DO you n-...~l a Temp CerUfloat.e: Temp'lnfonm~.on (If ,~NO Additional Inf°rmation: PAYMENT DUE WITH APPLICATION. 0 ,~, ~' ~ *'~'~ ~' ~ ., , . '( ~'~C~, ,.;, Tom~ Hail Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 BUILDING DEPARTMENT TOWN OF $OUTHOLD November 19, 2010 Mildred Cullen PO Box 1569 Southold, NY 11971 RE: 805 Goose Creek Lane, Southold TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupency __ Application of Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. __ A fee of $50.00 Final Health Department approval. "~-- Plumbers Solder Certificate. (All permits involving plumbing after 4/1184} __ Trustees Certificate of Compliance. (Town Trustees #765-1892} __ Final Planning Board approval. __ Final Fire Inspection from Fire Marshal. __ Final Inspection from the Building Dept. __ Final Landmark Preservation approval. Building Permit: 36008-Z bathroom alterations SHOWoER 4'-0" BATHROOM 2 SCALE: 1/4"= f-O" TO~Gw/6 ~ BEFO~ 1980. BATH~3 L CLG.HGT: 7'-2" BATHROOM 3 SCALE: 1/4"= f-O' I~THl~ W~ ~)EZ) BEOR[ 1980. BEDROOM 2 BEDROOM 1 BEDROOM ON LMNG ROOM FOYER H 'L J EAT-IN KITCHEN PAP, AGE ~ APP~ AS N( TED DATE ///~/~) B.P.# ~00~' N(~TIFY BUILDING DEPARTMENT AT :~-~8o~ ~ ~ TO ~ ~ F~LOWING INSPECTIONS: '"~' ' ~vv,~ P~N I I IFOUN[v~ TTON- T~ REQUIRE~CALE: 1/8" ~ ~ FOR PO~ ~RED CONCRETE 2 RObG~ ¢;AMING. PLUMBING, S'~;DP','~,5 ELECTRICAL & CAULKING iNSU~A FINAL - CONSTRUCTION & ELECTRICAL MUST BE COMPL~ FOR C.G. EoSTRUCTJON ~ MEET ~E MENTS OF THE CODES OF NEW ATE NOT RES~NSIBLE FOR R CONSTR~TI~ ERRORS. t UNO~W :T¥' OR .AWFu,_ 3ERTIFIOATE TERn ~ERTIFiC,:,i.. :.QUIRED _ BASEMENT PLAN AS-BUILT BATHROOMS ON THE FIRST FLOOR AND IN THE BASEMENT AS-BUILT PERMIT APPLICATION AS-BUILT BATHROOMS AT THE OULLEN RESIDENCE SOUTHOLD, NY 805 GOOSE NECK LN ARCHITECT FRANK UELLENDN"IL 123 CENtRaL ArgUE P.O.BOX 316 GREENPORT, ~ 11944 EL 631-477 8624 OWNER MILDRED CUUEN 805 gOOSE NECK LN SOUTHOU), NY 11971 TEL: 651-765-5280 DATE: 11/04/2010 ~: 1/8' =1'-0' BATHROOMS FLOOR PLAN AS-BUILT DWi. A-1 NOVEMBER 4, 2010 FRANK W. UELLENDAHL, ARCHITECT P.O. BOX 516 GREENPORT, NEW YORK 11944