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40146-Z
/,� S�FEDt,{rco Town of Southold 10/23/2015 } ' . -o P.O.Box 1179 1 0 t;` 53095 Main Rd ` -0'i Southold,New York 11971 - ,tn CERTIFICATE OF OCCUPANCY No: 37854 Date: 10/23/2015 THIS CERTIFIES that the building AS BUILT ADDITION Location of Property: 2895 Eugenes Rd, Cutchogue SCTM#: 473889 Sec/Block/Lot: 97.-3-20.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/28/2015 pursuant to which Building Permit No. 40146 dated 10/2/2015 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"DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Goeller,Thomas of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED J Au id ignature BUo, sUtx TOWN ILDING OF SOUTHOLDDEPARTMENT ". eon TOWN CLERK'S OFFICE oy o� 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#: 40146 Date: 10/2/2015 Permission is hereby granted to: Goeller, Thomas PO BOX 1198 Cutchogue, NY 11935 To: legalize an as built deck addition as applied for. At premises located at: 2895 Eugenes Rd, Cutchogue SCTM # 473889 Sec/Block/Lot# 97.-3-20.1 Pursuant to application dated 9/28/2015 and approved by the Building Inspector. To expire on 4/2/2017. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $968.00 CO -ADDITION TO DWELLING $50.00 Total- $1,018.00 wilding I V,sector 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%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. 0,77,,s7/,5" New Construction: Old or Pre-existing Building: (check one) Location of Property: 2 8 C �-/ L,776 &X- House House No. S5t / Hamlet Owner or Owners of Property: ' J( ��//� N 60 Suffolk County Tax Map No 1000, Section 9 7 Block Lot Subdivision Filed Map. Lot: Permit No. 40 /cic Date of Permit. Applicant: /v1 V7x SC/I w404CT Z- Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 5 b '121° Si Applicant• e Ee)7- 62---- "''�'4*Of SDUIdp „, , cr, <9 N 1 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST ' [ ] ROUGH MBING [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING / STRAPPING [ INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 4, 4 _ co /AM 16)DATE c-1 (3-' INSPECTOR I' 41%4 . TT FIELD DISPE ON OAT DATE t-‘..--,. .. COIv�i12E`NT _ ►i..L.1,.,. c' a 'OUNDiA. 'SON(1S11) 1 FOUNDATION(2ND) ' x.16 _ rZ i?®® ROUGH FRA & •-• . . .. . ..• , ..r�. t PLUMBING —,—,----- . , • • 'C ti IH INSULATION PER N,Y. • . . . STATE ENERGY OOZE ' . _,.. O ,114'rei 0 .. f /' F3NAL • • • 11111111111 ,: . GI • • t i ..j t . -e 2 . . . i . .. q . , . . . . . , . N • ti .� r V- ' / , ... r 2 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 119714 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. O( Check Septic Form _ ( — N.Y.S.D.E.C. �. - • - - �!; j; \;.� r� Trustees C.O.Application Flood Permit Examined ,20 S P 2a�J Single&Separate ' I Storm-Water Assessment Form Z- RDC DEPT Contact: TOR 0r SOUTNe1f G Mail to: / Approved 20 ____ ,` Disapproved a/c _ ��/ � r4//— J Phone: (6(� Expiration 1' , 3 .. ►e 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 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 commericed 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,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 name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, age architect, en_ineer, general contractor, electrician, plumber or builder Name of owner of premises Te517 f/r/j-ff -A/: +Vv f�,� • (As on the tax roll or 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 No. 1. Loc tjjau of*id o whit roposeddworkwillone: be d 9 ria&" b--/v _ Ce, ycbte House Number Street Hamlet County Tax Map No. 1000 Section / 7.J i,�'Y '0:1 Lot 270 .fP. „ ,.:r+-'�•? ';i LPj"1L r+5 .i•i 'ai"�`_�.,Gsa l i> t 101 _'.E AMiK Subdivision Filed Map No. Lot 2. State existing use and occupancy of premii and tended use and occupancy o proposed construction: a. Existing use and occupancy 6 (//it--4,,,, b. Intended use and occupancy d 1/4g 4✓/ O &4 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other WorkU/(.r7 PE c-4 (Description) 4. Estimated Cost Fee -c.7 „-,),,: ,., :, frAiro 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, corerci or mixed occupaacy, specify nature and extent of each type of use. 7. Dimensions of existingstructures, if any: Front 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 Nu ber 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 -.- 85:1.0 12. Does proposed construction violate any zoning law, ordinance or regulation? YES , NO K 13. Will lot be re-graded? YES NO YWill excess fill be removed from premises? YES X. NO 14.Names of Owner of pre es 6'0 C--( - Address Phone No.7�6 + p" Name of Architect � C G G✓:}/e r, Address Phone No 7J !1 L/ Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ,V\ NO * 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. 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 g * IF YES, PROVIDE A COPY. STATE OF NEW YORK) ' SS: COUNTY OFS /f( K- . Ailtie,,r____ ei--/(4----:/be/ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the ll<C#7- 7 --- (Contractor,Agent, Cor orate Offic , 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 / / S+n day of mber- 20 15 / •. , ' . JAao2a119° U 2 TRACEY L. DWYER Notary Pu Ti NOTARY PUBLIC,STATE OF " '•'' S IWof Applicant NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,22!.E3 /. G so ,E_ L. e_. ,, - „, -rvia . Scott A. Russell ,,••49'�s����f`V'. ST(0)RMWA\T)ER SUPERVISOR ; N j SURVEY OF V L O; 7 IN MAP OF MINOR SUBDIVISION PREPARED FOR SCO 7-T KA UFMAN ,� Si TUA TE c n AN 81° 43' 00" E N/F L O VENO RESIDENCE 309.30' ,'� EAST SUFFOLK COUNTY, NI. Y DU 7HDL D Lr° 80Lr IN w STUMP ', y f 0 Q / © SURVEYED FOR THOMAS U. G CEL!ER., � aA----.....,A-e-fy,,`� ;% % �� SHARON W GOELLERa JI -�01, / ! 0-1 o 0 Q o/ 114 ®I. FRAME O TAX MAP NO. _ ( ®i�l� 9' SPIED f* 1000-007-0.3-x'0,1 `y0 ct. �i j/� � 9. 6 1�t2`9 2970—- Rl ZONED R1-80 � � �` 3� SLA7£ +,0 qtt6 z�s.STORy 4a 3 P PCSlDEP10E .:::..---:2_____ sur,vr rFn ar MARCH, aono �� k - r L7� _ c, + � f ti ARCA T 740,O60 SF c� / / \� ¢ �P�P�t \ N/F KAUFf�1AN it \ .S 210 ACRES k,' p�` / -- ,9!r�q \ `* rQ, 1ax2s VACANT \ ' /045- : . w/I�nrcrxc: LOT"?_ r _ ACL WATER--; d,; r/f(rrt'' � N/F l%I Ir�ANG \VAC AN T / � , _ ONE X 1tOusr/WrLL o C A ) oofrc r 4J-got I 1 '—�,, �- M y0��'�1•4 , ::-A.4- r,o"i �y figs r i ELEVATIONS SHOWN ARE kJ \-- - r — t' t -Y- NVGD SM I-1.326 13ESr T 7968 i �� 1 ZONE Vr� AE (1-7.1_8) �� ..x, ,.4 ELEV..: 1,3,052 Z crn - L' ` '� 4 GUARANTEED TO . 1 �' THOMAS 0. GOELLER —'" ---:;1., w ' �'"-.,` '.- SHARON W. COELLER ' iii (- FIDELITY NA 7/ONf1l. TT TLF_ WS, CO. U rtE To SKUNK LA I,�RIDGFhlfihll'TON N/1 TlON�tf_ E3fiNY, I fp M `� S 76° 50 30 ' W 7 93.02' ^1,128, 3' TOWN OF SOUTrlOLl� �c s.�l 225.50' S7 �,____,______- T-^ ___�--- -(JC�EN� ' ROAD suf�vE�rrJ fir STANLEY J. 1S.4KSEN, JR. NP .O. TJX 294 ____ -- - — NEW _�LJF FC�1_K, N Y 1195 0. 20 JUNE, 200i' FINAL SIJI?VrY 631-'V43°:1,:.5.8.36f L� r------- 5. 7 NOVEMBr.R, 2001 LOCATE POURED CoNC 112 RE FOIJNDi 17ON. 4, 70 JULY 2001 ADO FLOOD ZONE IMES, `_� �,/ __ - L� �� 79 JUNE!, 2000 REVISE SANITARY AND �ti;_'H LOCATION. f .414:-....Z.,....../' L NSE{) L�ND , rl ?'CJt�' �� 2. 07 JUNE. , 2000 RE 1'7SE SANITARY AND EAR P/wORK, W YS 1 1 C; NO. 49'2 1. 72 MAY, 2000 SI-!OW 0.EG. WC7LANOS DETE MINA llON, 1-Li Lr_{ REVISE LOCATION OF HOUSE, SANITARY J.; WO_L. r