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36995-Z
Town of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 6/26/2012 CERTIFICATE OF OCCUPANCY No: 35781 Date: 6/26/2012 THIS CERTIFIES that the building FOUNDATION Location of Property: 205 West Rd, Cutchogue, SCTM #: 473889 Sec/Block/Lot: 110.-7-12 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore 8/3/2011 pursuant to which Building Permit No. Lot No. filed in this officed dated 36995 dated 2/14/2012 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: concrete piers under an existing building as applied for. The certificate is issued to Pequash Rec Club lnc (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 36995 Date: 2/14/2012 Permission is hereby granted to: Pequash Rec Club Inc Attn: Walter J Krupski Jr 315 Pat Ln Mattituck, NY 11952 To: repair an existing foundation under per trustees approval At premises located at: 205 West Rd SCTM # 473889 Sec/Block/Lot # 110.-7-12 Pursuant to application dated To expire on 8/15/2013. Fees: 8/312011 and approved by the Building Inspector. NEW COMMERCIAL, ALTERATION OR ADDITIONS CO - COMMERCIAL Total: $250.00 $5O.OO $300.00 Building Inspector Form No. 6 TOWN O~ $OUT~OLD 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 following: .4. For new building or new use: 1. Final survey 9f property with accurate location 0fall 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 0fFire Underwriters. 4. Sworn statement from pinmbcr certifying that the solder used in system contains leas than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple reaideacee and similar buildings and installations, a ccrtificat~ of Code Compliance from architect or anginoen: responsible for the building. 6, Submit Planning Board Approval of completed site plan requi~mcnts. 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, s~, building and:unusu:il n~ural or topographic features. 2. A properly completed appticafion 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 o f Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00' · Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00~. 2. Ceytifieate of Occupancy on Pre-existing Building - $t00.00 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 Hew Construction: Location of Property: Suffolk .County Tax Map No 1000, Section Subdivision ~ Old or Pre-existing Building: (check one) No. Stre~i Block Permit bio. ;5~' qq.5 .DateofPermit.~ - / ~'-/~ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Foe Submitted: $ ~'~0 , ~r'~/~L/' Date. Applicant: Under~triten Approval: Final Certificate: k~// (check one) Filed Map.. Lot: Hamlet TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCllON [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMA~c~ INSPECTOR~ ~ DATE ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY fl SPECTION [ y]'~FOUNDATION 1ST [ ] ROUGH PLBG. 21~493 Mail~ Road · PO Box 1~51.734.4 May 11, 2012 Southold Town Building Department P.O. Box 1179 54375 Main Road Southold, New York 11971 Re: Pequash Recreation Club 205 West Road Cutchogue, New York (SCTM#1000-110-07-12) To Whom It May Concern, I have been on site during the construction phase at the aforementioned property. The footings for the Pequash Recreation Building are sufficient for the load of the existing one story building. Please call this office if you have questions or require additional information. MAY 1 4 2012 BLDG. DEPT. TOWN OF SOUTHOLD TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.North Fork.net Exanlined Disapproved a/c Expiration PERMIT NO. Building Inspector 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. Trustees Flood Permit Single & Separate Storm-Water Assessment Form Contact: Mail to: Phone: APPLICATION FOR BUILDING PERMIT Date ,20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in iuk and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee accordiug to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to a4joiuing premises or public streets or areas, aud waterways. c. The work covered by this applicaion may not be commenced betbre issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issne a Building Permit to the applicant. Such a permit shall be kept on the premises available [bt iuspecfion throughout the work. e. No building shall be occupied or used in whole or in part for auy purpose what so ever until the Buildiug 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 bas not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted m the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a ne~ permit shall be required. APPLICATION IS HEREBY MADE to the Building Depamnent for the issuance ora Btfildiag Permit pursuaut to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and otl~r 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 name, ifa corporation) ~Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or boilder Name of owner ofpre,nises B~"(~)d,'~3'''/-/ //~"C/~r-~ nO/.J (As on the tax roll or latest deed) ~,}, si~ture of duly at~horized officer,_. ; ( ame and title ~rpo~ ~' 5C C~ Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. L~ation of land on, wi)ich proposed work will be done: w..o 5 l/V 5'r- o /t-0 House Number Street CUT-Ci4 6 Hamlet County Tax Map No. 1000 Subdivision Section Block Filed Map No. Lot Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupaucy ,,~-~-~'/d-e'Tq 7-/O~t.,/ C-~ c/g~ b. Intended use and occupancy /~-C/'~..'-~ T-lO/ti C~,wZ3 Nature of work (check which applicable): New Building Repair Removal Estimated Cost ~.0~"~OO~, O O If dwelling, number of dwelling units If garage, number of cars Addition Alteration Demolition Other Work ~b,qC_,/geT~- to/e'Rs' 7-0 8¢ I/0'577,~e0 uWp~re ~t~r/,~,z [3X 6 po~'l-_~ (Description) Fee (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 existing structures, if any: Front ~o t 5/ Height ~/~ 2,5' ~ Number of Stories / Dimensions of same structure with alterations of additions: Front Depth. 2.~' ~ Height ,.-- P--O' Number of Stories /¢ ///2.. 8. Dimensions of entire new construction: Front Rear Height Number of Stories 9. Size of lot: Front /0~ / Rear /Do / Depth .Depth 10. Date of Purchase Name of Former Owner 11. Zone or nsc district in which premises are situated 1 2. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO ~ 13. Will lot be re-graded? YES __ NO Will excess fill be removed t¥om premises? YES NO 14. Names of Owner of premises Address ~t-'rl'P-~o~r°( W~t I1~?~' Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES ~- NO __ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES NO * IF YES, D.E.C. 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO X · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF'~F'F'dt'-/c SS: ) (Name of individual signing contract) above named. (Confradtor, A=ent. Corporate Officer, etc.) being duly sworn, deposes and says that (s)he is the applicant CONNIE D. BUNCH Nota~ Pu~li~, Slate of New York NO. 01BU6185050 Quaiil-md in ~UfiO~K Gounty Commieslon Expires April 14, of said owner or owners, and is duly authorized to pedbrm or have performed the said work and to make and file this application: tbat all statements contained in this application are true to the best of bis knowledge and belieh and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me tiffs, ~k~-C-~ day of ~t,,{~ 20 ] ) Notary Public Town HMI, 53095 Main Rd. PO Box I 179 Southold, NY 11071 Telephone (631 ) 765-1892 Fa~ (631)765 6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7707A Date of Receipt of Application: December 22, 2011 Applicant: Pequash Recreation Club, Inc. SCTM#: 110-7-12 Project Location: 205 West Rd., Cutchogue Date of Resolution/Issuance: January 18, 2012 Date of Expiration: January 18, 2014 Reviewed by: Board of Trustees Project Description: To install nine (9) concrete piers (12" dia.) under existing 6"X 6" posts to stabilize the foundation of the existing building. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations indicated on the foundation plan prepared by Mark K. Schwartz, AIA dated Apdl 7,2011 and stamped approved on January 18, 2012. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James)'~nl~g, Presi~/~ Board ~Sf Tiusteesc~' ~ James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971~0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0756C Date: June 8~ 2012 THIS CERTIFIES that the installation of nine (9) concrete piers (12" dia.) under existing 6'x6" posts to stabilize the foundation of the existing building. At 205 West Road, Cutchogue, New York Suffolk County Tax Map # 110-7-12 Conforms to the application for a Trustees Permit heretofore filed in this office Dated December 22, 2011 pursuant to which Trustees Administrative Permit #7707A Dated January 18, 2012 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of nine (9) concrete piers (12" dia.) under existing 6"x6" posts to stabilize the foundation of the existing building. The certificate is issued to PEQUASH RECREATION CLUB, INC. owner of the aforesaid property. Authorized Signature TOWN OF SOUTHOLD i:~OPERTY RECORD CARD _ 'OWNER , FORMER OWNER LAND IMP. VL. i FARM TOTAL ~ DATE AGE BUILDING CONDITION NEW Form Tillable 1 Tillo'ble 2 W /4~ ~.~.l,.S TYPE OF BUILDING NORMAL Ac re Tilloble 3 Wcodlond BELOW '~¢ ABOVE Volue Per Acre Volue Swomplond B r ushl~l~;~l ~=~ House Plot Tetal SUB, LOT Extension Basement Floors Ext. Walls 4,~ ~ ~ Interior Finish Extension. I v~ Extension Fire Place / He~ ./~ ~ Porch Attic Parch Rooms ]st Floor Breezewa' Patio Rooms 2nd Floor Ga rage Driveway TOWN OF SOUTHOLD I~OPERTY RECORD CARD 'OWNER STREET FORMER OWNER VL. l FARM TOTAL DATE VILLAGE I DISTRli'r SUB. LOT LAND P. AGE NEW Farm Tillable 1 Tilla'ble 2 Tillable 3 Wcodland BUILDING CONDITION NORMAL BELOW ~* ABOVE Acre Value Per Acre Value Swampland Brushl~i ~ House Plot TYPE OF BUILDING COMM. iND. CB. JMISC. J/'~ I I ~ . .~ . ~ L I ~, Total Extension ? X ~, o '~ / ~zD (( / ~ ~> /~ o /~ ~ r? Basement ' "~ Floors Extension Ext. Wolls ~ Interior Finish Extension Fire Place I Hea* ~' ~, ~ Porch Attic Porch Rooms 1st Floor Breezeway Patio Rooms 2nd Floor Ga rage Driveway O.B. Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~0OO I I 0 '~ ~'~" STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN I~t,ct section mock Lot GI~ ~ ;re=u BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUurlON ITEM# / WORKA,SSESSMENT [ Yes No a. What is the Total Araa of the project Pamels? Will this project Retain Ni Stsrm. Watsr Ron. Off (Inctsde Total Ama of all Paroels Iocatad wtihth ~ .~" A C//.E~ I C-eneratad by a Two (2") Inch Rainfall on Site? ~ ~' o, W. ~r,;~. ~n, b. What b the Total Ama of Land Ctsarlng (S.F. / .~) ('I~is itsm will Include all run-off oreatad by sita cleating and/or construction actMtias as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction ac'E~ly? impervious surfaces.) PROVED[ BIU~2z PROjeCT DF. SC~J~ON ~-=:-.;~ ~-~ Drainage Stmcturas Indicating Size & Location? This Item shall Include all Proposed Grade Changes and -- ~TX CCT-/d (; ~a~ {o'°/~O ~"F£, 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to control site erosior~ and storm water discharges. This -- item must be maintained throogbeut the Entire Construction Pedod. 4 Wiil Ih S Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Ma edal within any Parcel? 5 Will this ApPlication Require Land Dislurbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? -- 6 ~s them a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred (100') fast of a Wetland or~ -- mq~imd, pe~t-constmctkxl stsem wate~ management [x'actlces ~at wi be used and/or Removal of Vegetation and/or the C~mstruction of any r~ STATE OF NEW YORK, <~/~, ~. Nofa~ Public, State of New York COUNTY OF ............%~ ~ "...~...r .:. ...................... SS No. 01BU6185050 ~/.. ___ -w- , ....... . ~ Qualified In Suffolk County .~. ~,at I ............................................................... : .............. ~ they ,~orn, depots and ,&~ li~ll~,~tioh is the ......... --/(o,,~t, c,~,~. ~;.r~. ~ ~.'~'a ................................................................ Owner and/Or representative of the Owuer or Owners, and is duly authorized to perform or have performed the said work and to make and tiJe this application; that all staU'Jnents con.ned in this application are l]'ue to the best o£his know[edge and belief; and that the work will be performed in the manner set forth in the application tiled herewith. Sworn to before me this; ............. ................... .......... /. .-- .............. FORM - 06110 5CALF=: ~0' = 1" VALI TdYL a 50~J 38'-4" 51 '-2" 5'-10" 5'-1" 4'-8" 7'-8" 7'-11" ~ EX. STEP 12'dia, CONC. PiER UNDER EXISTING OZ 6X6 POSTS -- 3' BELO~U GRADE II 12"dia. CONC. PIER UNDER EXISTING 6X6 POSTS 3' BELO'CU GRADE ¢'YPICAL) EXISTING FOUNDATION UNEXCAVATED ,.~ ,': ,~ TOWN COD[ aND CONDITIONS t SOUTHOLD TOWN ZBA SOUTHOLO TOWN PLANNING BO, SOUTHOLD TOWN TD! ~?EES EXIFFING FP FOUNDATION EXff'rlNG BLOCK ~ALL 58'-4" FOUNDATION PLAN SCALE: 1/4" = 1' EX. I~M~4 P , UUw'. o SE z ~AS NOTED REVISIONS: I o AM TO 4 i- ~ FOR ~> FORE IRED C©N¢'~ _ : ~ ~ STRADP NO ELEC .... ,,, r ~ ~ REQUH: ~ '-~ r TH[ A-1