HomeMy WebLinkAbout38991-Z F�. Town of Southold Annex 7/18/2014
9
" P.O. Box 1179
54375 Main Road
W Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 37033 Date: 7/18/2014
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 6105 Sound Ave, Mattituck,
SCTM#: 473889 Sec/Block/Lot: 121.-1-4.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
4/30/2014 pursuant to which Building Permit No. 38991 dated 6/25/2014
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:
"AS BUILT"IN-GROUND SWIMMING POOL WITH RAISED SURROUND AND SECOND FLOOR BEDROOM
ADDITION AS APPLIED FOR
The certificate is issued to Gatz,Donald
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38991 05-28-2014
PLUMBERS CERTIFICATION DATED lop
t riz Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
• �l 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#: 38991 Date: 6/25/2014
Permission is hereby granted to:
Gatz, Donald
PO BOX 1486
Mattituck, NY 11952
To: as bit" inground swimming pool/surround and 2nd fl. bedroom addition as applied for
At premises located at:
6105 Sound Ave, Mattituck
SCTM #473889
Sec/Block/Lot# 121.-1-4.5
Pursuant to application dated 4/30/2014 and approved by the Building Inspector.
To expire on 12/25/2015.
Fees:
AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $1,720.00
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO -ADDITION TO DWELLING $50.00
Total: $2,020.00
Building Inspector
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 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%0 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 topographic
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$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. 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. y—8-zo&
New Construction: Old or Pre-existing Building: (check one)
Location of Property:
House No. ,,,, 1Street Hamlet
Owner or Owners of Property: 1 0.4 k �
Suffolk County Tax Map No 1000, Section MIR Block 0/ Lot Vs
Subdivision �rfBn �A�26le S Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
F _ 3 a0F SO(/T
_ hod' y�lo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1171-0959 rop
Southold,NY 11971er.riche_ rt(a-town.southold.ny.us
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Donald Gatz
Address: 6105 Sound Ave City: Mattituck St: NY Zip: 11952
Building Permit#: fig)fw(;;? Section: 121 Block: 1 Lot: 4.5
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 X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor Pool X
New Renovation 2nd Floor X Hot Tub
Addition X Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 8 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors 1
Main Panel A/C Condenser Single Recpt Recessed Fixtures 6 CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency FixturesH Time Clocks
Disconnect Switches 4 Twist Lock Exit Fixtures TVSS
Other Equipment: 2 nd floor bedroom addition and in ground swimming pool, pool to include--
pool bonding,1-pool light,time clock,1-GFCI recpticle,1-pool pump recpticle
Notes:
Inspector Signature: Date: April 28 2014
81-Cert Electrical Compliance Form.xls
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING
[ ] FOUNDATION 2ND [ ] INSULATION
[ ]
FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) 44ECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE r INSPECTOR
SO�jyO
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLUMBING
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ /FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING .
REMARKS:
AV4,,! !�
DATE INSPECTOR
IJ� /
C of sou
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGLUMBING
[ ] FOUNDATION 2ND [ ] 1 CATION
^�
[ ]
FRAMING / STRAPPING [ FINAL �
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE l INSPECTOR
FMLD INSPXSVON RICPOFrT DATE COIVIIVims
FOUNDATION(1ST) S
FOUNDATION(3ND) C
o
rA
ROUGH FROIINCf&
PLUMING
Cr!
INSULATION PER N.Y.
H
STATE ENERGY COVE
y
97/
FINAL
e�
. o
N
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you haver or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 /sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
"SoutholdTownNerthFork.net PERMIT NO. �'L � Check
SepticForm
N.Y.S.D.E.C.
Trustees
Flood Permit -
Examined 20� Storm-Water Assessment Form
Contact:
Approved ,20L(_ Mail to:
Disapproved a/c
Phone:
Expiration _ T_T__,20
Builduxg Inspector
APPLICATION FOR BUILDING PERMIT
Date , 20
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 throughdtit 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 of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold,-Suffolk County,Ne'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.
I 1 '` Si f applicant or name if a corporation)
• � t)
State whether applicant is owner, lessee agent, architect,pp g engineer, general c "_ %R; V ilder
Name of owner of premises
(As on the tax roll or latelst Bib ffATION-TWO F,
If applicant is a corporation, signature of duly authorized officer FOR OURED C(-'
7.
ROUGH.
(Name and title of corporate officer)
INCLOSE ;F-':wL i v CODE w�
UPON COMPLETION t�lsAL`"c JfiJh a L'�"tGTi�%ht
Builders License No. BEFORE"WATER" MUST BE COMPLETE FOR C.O.
Plumbers License No. ; : . . ALL CONSTRUCTION SHALL MEET THE
Electricians License No. REQUIREMENTS`OF THE CODES OF NEW
YORK STATE.i NOT RESPONSIBLE FOR
Other Trade's License No. DESIGN OR CONSTRUCTION ERRORS.
1. Location of land on which proposed work will
be (done: }�
G 09" So c...✓d ,ANe N WGf 4 iT7'T6L4i
House'Number Street Hamlet
County Tax Map No. 1000 Section �� Block 0 Lot
Subdivision (grain QFiled Map No. Lot �
2. 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
3. Nature of work(check whichapplicable):New Building 'Additi'on Alterations
Repair Removal' Demolition Other Workyi nq Dool u I A u Mr ..ted
'( escription)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if anjFrontj� S key Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
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
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulatiop? 'YES NO
13. Will lot be re-graded? YES NO Will excess fill be removed from premises?YES X10
14. Names of,Owner of premises.:.. ,=a. Address Phone No.
Name of Architect I} 14a,a,' Address.. F .A - Phone No
Name of Contractor Address Phone No.
15 a. Is this property within-100 feet of a tidal wetland ora freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWNTR S_ TEES`&D.E C, PtW"ITS MAY BE`REQUIRED.
b. Is this property within J00.feet°of a Tidal'wetland? * I� '` �'NQ
* 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 feetor below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
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 true 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.
Sworn to before me this
day of 20
Notary Public Signature of Applicant
50-546/214 4720
DONALD W.-G �'Z
JACQUEL GATZ
6105 SOUND A E. nm J/- 2.01
MATMUCK, 11 2
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-1:0 2 i405464r: LOi 0005 i 0
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: `
Date:
Company Name: �..
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: f
*Address: -Sound RmLa . alb ht t
*Cross Street: t
*Phone No.:
Permit No.:
Tax-Map District: 1000 Section: 12-1 Block: of Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
(Please Circle AN That Apply)
Is job ready for inspection: YES/ NO. Rough In Final
*Do-you need a Temp Certificate: YES/ NO
Temp Infonmation(If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information- PAYMENT DUE WITH APPLICATION
,4(A
it IUD.
82=Request for Inspection Form 1 t-G "I `r
CONSENT TO INSPECTION
&Z2 dn& ,the undersigned, do(es) hereby state:
Owner(s)Name(s)
That the undersigned(is) (are)t owner(s) of the premises in the Town of
Southold, located at (/05 SDu i9Ud AIa
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section /07/ , Block a_,Lot S
That the undersigned(has) (have) filed, or cause to be filed, an appl*cation in the
Southold Town Building Inspector's Office for the following:
�,s�jp.0' ,Pder�
a 6aUe G a � an�
That the undersigned do(es)hereby give consent to the Building Inspectors of the
Town of Southold to enter upon the above described property, including any and all
buildings located thereon,to conduct such inspections as they may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordinances,rules and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances,rules or
regulations of the Town of Southold.
Dated: V—d'-,12 /o y
S'gnature)
T
(Print Name)
(Signature)
(Print Name)
TOWN OF SOUTHOLD PROPERTY RECORD CARD
l
STREET (> VILLAGE DIST. SUB. LOT 4
.01
�.
FORMER OWNER N E CR
S W TYPE OF BUILDING
RES- Z r ID SEAS. VL. f FARM COMM.
LAND IMP. TOTAL DATE REMARKS
Fars r � _ c e.�, 'Is
-
A c-y > 4 " v AZ40 6 � � � �L 1 ,.�� y t it r I .k,4 tic. 'A tlo. .a iA(--p4.4., �-15Cllt�
D `# C`1 O�L� , a' D U
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10300 , IO
��� ..ss
FRONTAGE ON WATER TILLABLE „tea_`=tsoo
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FRONTAGE ON ROAD WOODLAND g +
1
1 DEPTH MEADOWLAND f
r, b6a=
BULKHEAD HOUSE/LOT
TOTAL
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Rooms 2nd Floor
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PO.OL DIMENSIONS
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DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION
INDICATTEDED
(1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW (2)
HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHA.F TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)&CESSPOOLS(CP)SHOWN HEREON ARE FROM FlELG OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS.
\ 400 Ostrander Avenue, Riverhead, New York 111401
\ tel. 631.727.2305 fax. 631.7 27.0144
,
admin@youngengineering.com
of �oa���y�` Howard W. Young, Land Surveyor
Thomas G. Wolpert, Professional Engineer
\ �\� cl \ Douglas E. Adams, Professional Engineer
VJ Robert G. Tast, Architect
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-J 1`► �ENG� 23 , {- r,� RECORD OF REV1510N5 DATE
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59 � FINAL SURVEY MAY 25, 2000
UPDATE 5URVEY APR. 01, 2014
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CEDAR SHINGLES
ASPHALT SHINGLE ROOFING
ASPHALT SHINGLE ROOFINGASPHALT SHINGLE ROOFING , ,1
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ASPHALT SHINGLE ROOFING ASPHALT SHINGLE ROOFING Charles M. Thomas
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CEDAR SHINGLES PO BOX 877 JAMESPORT, NY 11947 (631) 727-7993
PROJECT
CEDAR SHINGLES
CEDAR SHINGLES CEDAR SHINGLES
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ELEVATIONS
DATE: 04/30/14
PROJECT No.
DRAWING BY. FS
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3 SCALE: 1/4"
THESE DRAWINGS AND ACCOMPANYING SPECIFICATIONS, AS INSTRUMENTS OF SERVICE, ARE THE EXCLUSIVE PROPERTY OF THE ARCHITECT AND THEIR USE AND PUBLICATION SHALL BE RESTRICTED TO THE ORIGINAL SITE FOR WHICH THEY WERE PREPARED. REUSE, REPRODUCTION OR PUBLICATION BY ANY METHOD
IN WHOLE OR IN PART, IS PROHIBITED EXCEPT BY WRITTEN PERMISSION FROM THE ARCHITECT, TITLE TO THESE PLANS SHALL REMAIN WITH THE ARCHI TECT.VISUAL CONTACT WITH THEM SHALL CONSTITUTE PRIMA FACIE EVIDENCE OF ACCEPTANCE OF THESE RESTRICTIONS,