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Home My WebLink About28357-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28485 Date: 06/05/02 THIS C]LRTIFIES that the ~uilding ALTERATION Location of Property: 1375 ACKERLY PD LA SOUTH/PEC (HOUSE NO.) (STREET) (HAMLET) County Tax ~ap No. 473889 Section 69 Block 5 Lot 7.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 3, 2002 pursuant to which Building Permit No. 28357-Z dated MAY 3, 2002 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 ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. Tg~e certificate is issued to WILLIAM J BERGRATH (OWNER) of the aforesaid building. SUFFOLK COU/FIIy DEPARTMENT OF HEALTH APPROVAL ELEC~I'RICAL C~ERTIFICATE NO. PLUMBERS CERTIFICATION DATED 12/06/01 N/A 52424 11/20/01 BILL BERGRATH ' ignature 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) PERMIT NO. 28357 Z Date MAY 3, 2002 Permission is hereby granted to: for : WILLIAM J BERGRATH 565 WOODBURY RD COLD SPRING HARBOR,NY 11724 ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR THIS PMT. REPLACES #26246Z at premises located at 1375 County Tax Map No. 473889 Section 069 pursuant to application dated MAY Building Inspector. ACKERLY PD LA SOUTH/PEC Block 0005 Lot No. 007.001 3, 2002 and approved by the Fee $ 174.00 Authorized Signature Rev. 2/19/98 COPY 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) PERMIT NO. 26246 Z Date JANUARY 6~ 2000 Permission is hereby granted to: for : PAMELA HUNT 1375 ACKERLY PD LA SOUTHOLD~NY 11971 WINDOW ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR (PROVIDE EGRESS). Amonded to include roof alterations. at premises located at 1375 County Tax Map No. 473889 Section 069 pursuant to application dated DECEMBER Building Inspector. ACKERLY PD LA SOUTH/PEC Block 0005 Lot No. 007.001 3~ 1999 and approved by the Fee $ 75.00 Autho~i~ ed Signature Rev. 2/19/98 COPY Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-1823 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: /' ~/t~ /0/ Building Permit No. Owner: (please print) Plumber: '~--'f~ t 1~ ~c2;t,,jT)~_ixJ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~' ~ day of~:g.d_~ 20 d_) / HELENE D. HORNE Notaw Public, State of New York Notary Public, No. 4951364 County Cmeii~ed in Suh:olk ~ounty Commission Exoiro.,~ M~,¢ Elec Yrical Znspec Hon CerHf /ca Ye Date Electrical Inspection Service, Inc. A_~=lication # 11/20/01 375 Dunton Avenue 52424 East Patchogue, New York 11772 (631) 286-6642 Issued to: Street: Village: Section: William BerGrath 1375 Ackerley Pond La Southold Zip: Block: Lot: Town: Southold Introduced by: Bay Village Electric (L) Lic.# 4632-E wes exomined ond found Yo be/n compl/ance w/th the AlaHona/ Electrical Code [] Commercial []NV Defects [] Pool [ lst FIoor []Indoor []Basement [] Hot Tub [] Residential [] Det. Garage [~Attic E~2nd FIoor [Outdoor [] Addition [~]Survey Switches Receptacles Fixtures 30 26 38 Dishwasher Washer/Amp Dryer/Amp 1 I 20 1 30 Furnace Oil Gas Circulator I 1 Meter Amps Phase UG/OH Telephone 1 200 I [] / [] 2 Other Equipment: 40 circuit w/main 1/2 HP Water Pump I~otorl GFI Heaters A/C Fans 8 Oven Range/Amp Garbage Disposal I G 1 Smoke Detector Bell Transformer 5 Television Carbon Monoxide 2 2 Building Permit # 262462 Hug'S. Surdi President Rough Inspection: 5/26/01 Inspector: Ed Scavelli Final Inspection: 11/20/01 ]nspector: Ed Scavelli This certificate must not be altered in any manner. Inspectors may be identified by their credentials 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 a 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. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling ~25.001~lterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessoO~oUiiding $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $ 100.00 3. Copy of Certificate of Occupancy- $25.00 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: Date. Old or Pre-existing Building: /~ ~~St et~d ~ House No. Owner or Owners of Property: ~'~--rv~_~ · Suffolk County Tax Map No 1000, Section ~ ~ Block Subdivision Filed Map. Permit N~:'- .... ) Date of Permit. ~Z--. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval.,~/~ Request for: Temporary Certificate Final Certificate: ~ (check one) Fee Submitted: Hamlet Lot Lot: (check one) AppliJ Sigr~at-ur'e/ BUILDING PERNIIT REVIEW CHECK LIST Owners Nmne: ~,3i \O~fl% (otq~ ..)/~ Architect/ Date Engineer: Submitted: SCTM #: District: 1,000 Section: ~::~0 Block: 5 Lot: "~. I_ Project Location: 1"~"'~5' }Of~ J~)0~ ~_oJ-~<,~ .~,~ SubdivisiOnName: Single & separate Required certffication: (Yes / No) Req Req. Zoning Districl: __ [Lot size Actual ] [Lot coverage Req Req Req [Fronl Yaxd __ Proposed: I [Side Yard Proposed ] [Rear Yard Project Description: AGENCY PERMITS REQUIRED FOR REVIEW Proposed Proposed: __ Suffolk County Health Dept. New York State D.E.C. N.A. NO YES Town Trustees Town Zoning Board approval: Town Planning Board approval: Flbod Zone:Flood Plane Elevation ??? Notes: Permit Number 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [-'~OUGH PLBG. ~FOUNDATION 2ND [ ] INSULATION ~kMING [ ] FINAL FIREPLACE & CHIMNEY '/~/~ ~p ~~ ~ ~DATE ~~~/ INSPE~OR ~ ~~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] F~UNDATION 2ND [ - I~NSULATION [~/J/FRAMING ~ [ ]FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~~q~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] IN~JLATION [ ] FRAMING [ ,~ FINAL [ ] FIREPL/~ACE & CHIMNEY .EMARKS: ~/~_~:~./~ ~-.~_~ DATE //f//,~/~ INSPECTOR 765-~,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSU~.ATION [ ] FRAMING [ ] FIREPLACE & CHIMNEY DATE FIELD INSPECTION P~PORT FOUNDATION ( IST) FOUNDATION (2ND) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY DATg II ~ / [;,/-- .. / ~ ~ ~/ ~ / -~- CODE ADDITIONAL .FORN l~0. ] TO~I OF SOUTIIOLD BUILDING DEPARTHENT TOgN ~L SOU~OLD, N.Y. l]971 ~L: 765- ]802 ~(Buildi~ APPLICATION FOR BUILDING PgR.HIT INSTRUCTIONS ~UAKU O~ ~EALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SgPTIC FORH ................... C LL HAlL TO: .................... a. 'Ibis application mint be ca~letely filled in by t-ypa0riter or in ink and submitted to the Building Inspector 3 sets of plans, accurate plot plan to scale. Fee uceording to schedule. b. Plot plan shouing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, ~ giving a detailed description of layout of property -,,-t be dra~m on the diagrm ttaieh is part of this applieat ion. c. ~he fork covered by this application my not be comenced before isstumce of Building Permit. d. l~aon app~o~al of this application, the Building Inspector will issue a Building Pemit to the applicant. S~ch permit dm11 be kept on the lmmises available for inspection throughout the ~rk. e. No building ~ha11 be occupied or used in ~hole or in part for any pm-pose t/~ate~er until a Certificate of Occupancy shall have been granted by the Building Inspector. At'PLICATIC~I IS ~ 14PZ]~ to the .Building DepmCuent for the issuance of a Building Permit pursuant to the l~uilding Zone Ordinance of the To~ of Sonthold, Suffolk County, ~ York, and other applieuhle La~s, Ordinances or P~gulations, for the construction of buildings, additions or alterations, or for removal or d,~mlition, as herein described. The applicant agrees tO _~121y vith all'applicable la~s, ordinances, building code, housing code, and regulations, and to ~d~it authorized inspectors p~v,dses and on in building~pr neces~ j~pections. N.Y, STATE BUILDING CODE. (Hailing uriaress of a~licant) Sta/e ~heEher. al.~licant is (x~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or b~ilder d!~_i/4///~ ............................................................................................ z~://..//.//. ~ ~. ~,(~, .~.~.. APPROVED AS NOTED (as on the tax roll or latest deed) If al~licant is a, eorp~ration, signam ofjiuly authorized officer. / / . - ~., ,/~.. ~-~-~-~-~-~-~-~-~-~ and ' ' -- ............ VOLLOWII~ ( t~t~ of co ' ate officer) .............. ;" '' 1 VOUNO~TION o lWO R~IUIR~D ~' USk I~ UNLAWPULFO,~U~.~.C~,~ CERTIFICATE lROUGH - ] · I~I/MBING i,de s ...................... .y.!THOUT ,. ...................... OF. OCCUPANCY ,,,^.. co.s-.uc,,o, BE COM~.~I~ ~O~ C.O. lileetricians License No ...................... ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, CO'~iST~'0~i0j~' '-" - -' x /../.75Z./ ................................................... - Bouse ~r ...... / Street ~ .......... liadet ~,ty ~ ~p ~. ~00o s~t~on ..... ~.~. ...... Blo~ .... ..ff. ......... ~ot ..... ..~..1 ..... Subdivision ...................................... Filed ~p No ................ Lot ............... 2. State existing use aed occupancy of ~ses and in~d~l use and occupancy o~f proposed con~tractign: . .(:~ ,~0~ ,',.;: !} Fature of ~ork (d~ck ~ida applicable): N~ I~ilding .......... Addition .......... Alteration . X .... Repair ............ l~,._~al ............. Derml it ion ............ Other Bork .................................. r ~Deacript icon) Estimated Cost ......................... fee .............................................. (to be paid on filing this application) If ck*elling, n~nber of Oaelling ~mits ............ Number of d~elling tmlts on each floor ................ If garage, mmber of cars ...................................... If business, oam,~rcial or mixed occupancy, specify nature and extent of each type of use ...................... Dimensions of existing structures, if any: Front ................ Rear ............... Depth ................. lleight ......................... limber of Stories ...................... Dimensions of sam structure with alterations or additions: Front ............... Rear ............... Depth .................... Beight .................... limber of Stories ............... Dimensions of entire new construction: Front ................ Rear ............... Depth .............. lleig~t ...i ..................... Numar of Stories ..................... Size of lot: Front .................... Rear .................... Depth .................... Bate of ~urchase ..................... Narc of Former Owner ........................................ Zone or use district in ~hich pr~,ises are situated .............................................................. Does proposed construction violate any zoning 1~, ordinance or regulation: ........................ Will lot be regraded .................... Will emmss fill be ~oved frcm premises: YES Na~es of Oaner of premises ........................... Address .............................. I~ NO .............. blaze of Architect .................................... Address .............................. Fnone No .............. Rare of Contractor ................................... Address ............................... Fi~one No .............. Is this property within 300 feet of n tidal wetland? * YES .......... NO .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions m pioperty lines. Giv~ street and block r~nber or description according to deed, and sho~ street n~es and indicate · Ether interior or co~r lot. .' ': '* ~' , ': *: ' ~ duly ~orn, deposes and says that he is the applicant No. 01 B0602093~ Oualified In Suffolk Cotm~ Term Exoires Mm'eh 8, 20 (Contractor, agent, corporate officer, etc.) said r~mer or cxmers, mxl is duly authorized to perform or h~ ~rfo~ am ~id ~ afl to m~ a~ file this ~licati~; ~a.t ail stat~nts cmta[~ in ~is a~l. lcati~ are t~ to the ~st of his ~1~ and tml. iefl and ;mt ~e m~ will ~ ~rfo~ in tim mawr ~t forth in ~e a~licati~ fil~ ~. ~m to ~fore ~ ~is~ -- ..... .... ' ...... - Lid _ t~O~ M. ~O~ ~ POBUC. ~ ~ ~ R.O. WIDTH R,O. HEIGHT ORDER FORM 5/8" LABEL: a/b 325 13S(I P. O01 PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS REQUIRED BY PART. 714 0~' N.Y. STATE BUILDING DOUBLE HUNG: VT-DH1-3042 2 Std. Insul. / Prime 2 Custom Colonial Ashford Divided Lite 2W1H 2 Screens: White 2 Jamb Size: 6 2 3-3/4 in. Ext, Flat CSG 262.00 524.00 40.O0 80.00 26.00 52.00 21.00 42,00 SUB TOTAL = $698.00 ~1111, I IIIIF__..J_]H R.O. WIDTH R.O. HEIGHT: 11' 4 7/8" LABEL: C 3 ' 4 5/8" DOUBLE HUNG: VT-DH3-3832 1 ,Std. Insul. / Prime 1 Custom colonial Ashford Divided Lite 2W1H 1 screens: White 1 Jamb size: 6 1 3-3/4 in. Ext. Flat CSG 809,00 809.00 120,00 120.00 47.00 47.00 21.00 21,00 SUB TOTAL $997.00 R.0. WIDTH : 2' 6" R.O. HEIGHT: 3' 4 5/8" DOUBLE HUNG: VT-DH1-2432 Std. Insul. / Prime LABEL: d/e/f 216.00 648.0£ 6 · 20d-D PAGE 1 DID,.,.-Ol'99(t~'ED) 10:58 SPEONI( L MBER (.,.RP TEL:516 525 155(I P. 002 ?~OB NO: 00O00100 susan / billy 3 Custom Colonial Ashford Divided Lite 2W1H 3 Screens: white 3 Jamb Size; 6 3 3-3/4 in. Ext. Flat CSG 40.00 120.00 21.00 63.00 21,00 63.00 SUB TOTAL $894.00 R.O. WIDTH : R.O. HEIGHT; 4' 5/8" LABEL: g/h/i DOUBLE HUNG: VT-DH1-24310 Std. Insul. / Prime Custom Colonial Ashford Divided Lite 2W1H 3 Screens: White 24.00 72.00 3 Jamb Si~e: 6 21.00 63.00 3 3-3/4 in. Ext. Flat CSG 229,00 687.00 40.00 120.00 SUB TOTAL $942.00 R.O. WIDTH R.O. HEIGHT: 6' 5/8" LABEL: j/k/1/m DOUBLE HUNG: VT-DH1-30510 Std. Insul. / Prime Custom Colonial Ash~ord Divided ~ite 2W1H 4 Screens: White 32.00 128.00 4 Jamb Size: 6 21.00 84.00 4 3-3/4 in, Ext. Flat CSG 304.00 1216.00 40.00 160.00 SUB TOTAL $1,588.00 PAGE 2 6.20d-D DE-,C;.-01' 99 WED) 1(1:$8 SPEON}( LIi~.IBER CORP. TEL:516 325 1350 P. 005 JOB NO: 00000100 susan / billy R.O. WIDTH : 6' 3 7/16" R.O. HEIGHT: 6' 5/8" LABEL: n DOUBLE HUNG: VToDM2-30510 Std. Insul. / Prime Custom Colonial Ashford Divided Lite 2W1H 1 Screens: White 40.00 40.00 1 Jamb Size: 6 1 3-3/4 in. Ext. Flat CSG 21.00 21.00 615.00 615.00 80.00 80.00 SUB TOTAL $756.00 R.O, WIDTH : 2' 6" R.O. HEIGHT: 4' 5/8" LABEL: o basement DOUBLE HUNG: VT-DH1-24310 Std. Insul, / Prime Custom Colonial Ashford Divided Lite 2W1H Screens: White Jamb Size: 6 3-3/4 in. Ext. Flat CSG 229.00 229,00 40.00 4O.OO 24.00 24.00 21.00 21.00 SUB TOTAL = $314.00 PAGE 3 6.20d-D OCCUPANCY OR . SU,LD,NQ UEp,~ USE IS UNLAWFUL WITHOUT CERTIRCATE OF OCCUPANCY. APPROVE) AS NOTED 1. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE ROUGH . FRAMING & PLUMBING 3. INSULATION 4. FINAL . CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES· NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERROR8