HomeMy WebLinkAbout40273-Z o`pSUFF�tpcOG Town of Southold 8/30/2016
s , P.O.Box 1179
0
o ?# 53095 Main Rd
o4,1 �ySouthold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38486 Date: 8/30/2016
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 1775 Indian Neck Ln,Peconic
SCTM#: 473889 Sec/Block/Lot: 86.-5-9.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/9/2015 pursuant to which Building Permit No. 40273 dated 11/16/2015
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"ALTERATION FOR WORKSHOP AND BATHROOM OVER GARAGE IN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Wexler Donna M Revoc Trust
J
s
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40273 08-17-2016
PLUMBERS CERTIFICATION DATED 07-29-2016 George Berry Jr
Autho ' d Signat e
1
oco TOWN OF SOUTHOLD
FO(,�
BUILDING DEPARTMENT
y Z TOWN CLERK'S OFFICE
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#: 40273 Date: 11/16/2015
Permission is hereby granted to:
Wexler Donna M Revoc Trust
1775 Indian Neck Ln
Peconic, NY 11958
To: legalize an "as bit" alteration to existing space above attached garage in single family
dwelling as applied for.
At premises located at:
1775 Indian Neck Ln, Peconic
SCTM # 473889
Sec/Block/Lot# 86.-5-9.1
Pursuant to application dated 11/9/2015 and approved by the Building Inspector.
To expire on 5/17/2017.
Fees:
AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $836.80
CO -ALTERATION TO DWELLING $50.00
Total: $886.80
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% 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.
New Construction: Old or Pre-existing Building: (check one)
Location'of Property:
House No. Street Ha let
Owner or Owners of Property: 'Oamhly- 41 f�s
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. Lf0 �3 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning,Board Approval:
Request for: Temporary Certificate Final Certificate:_ ® (check one)
Fee Submitted: $
App scant Signature
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Town Hall Annex Telephone(631)765-1802
54375 Main Road C Fax(631)765-9502
P.O.Box 1179 roger.riche rt(cD-town.southoId.ny.us
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Donna Wexler
Address: 1775 Indian Neck Lane City: Peconic St: New York Zip: 11958
Building Permit# 40273 Section: 86 Block 5 Lot: 9.1
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 1st Floor Pool
New Renovation 2nd Floor x Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 6 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 3 Wall Fixtures Smoke Detectors
Main Panel 1 A/C Condenser Single Recpt Recessed Fixtures 3 CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture 2 Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 7 Twist Lock Exit Fixtures TVSS
Other Equipment: 1- Paddle Fan, 1- Exhaust Fan
Notes:
Inspector Signature: Date: August 17, 2016
OOElectrical 81 Compliance Form.xis
I
FRIC
Town Hall,53095 Main Road ® Fax(631)765-9502
P.Q.Box 1179 Telephone(631)765-1802
Southold,New York 11971-0959 .�
V BUILDING DEPARTMENT
D
V DD
TOWN OF SO OLD
AUG — 4 2016
BUHMINGDEFE (CERTIFICATION
TOWN OF SOUTHOLD
i Date:
Building Permit No. _400a
(please print)
Plumber: 6 !)(
lease print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
t/kllumber406iture)
Sworn to before me this �g
day of 20 fig'
SM11 L eERRY
yspm%Stateof NowYCt
��&t'4j .o1SE4694689
ougow In suffoh, Couty ®
`�,t+rm E�tr�L �'ssi llb
Notary Public, County
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTI N
'9
Ro
FOUNDATION I ST T GH PLUMBING
FOUNDATION 2ND SULATION
FRAMING /STRAPPING FINAL -
FIREPLACE4 CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION CAULKING
0
REMARKS:
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V - 1 I
DATE INSPECTOR/�� '�
pF SOUr'yo
• �o
coUNi'1I
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
. INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLUMBING
[ ] FOUNDATION 2ND [ ] INS ON
[ ] FRAMING /STRAPPING [ IN L
[ ] FIREPLACE A CHIMNEY [ ] FIRE =INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAU ING
REMARKS: --
DATE �� INSPECTOR
OF SO�lyolo
111 N o
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
REMARKS:
DATE f ? I� INSPECTORnift -
69
JAMES J. DEERKOSKI P.E.
260Deer Drive
Mattituck,NY 11952 D
(631) 774 7355
Date: May 16, 2016
MAY 2 3 2016 DD
To: Town of Southold Building Dept BUILDING DEPT.
TOWN OF SOUTHOLD
Re: Insulation Inspection
Wexler
1775 Indian Neck Ln.
Peconic,NY 11958
Permit#40273
To Whom It May Concern:
This letter certify that a Insulation inspection was performed at the above mentioned
property and all insulation was installed as per plans, and it meets all state and local
codes. Any questions feel free to call.
r` of r1EW incerely,
DEER�0
CO
z es Deerkoski P.E.
�opROFESS
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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 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 Single&Separate
Storm-Water Assessment Form
16 Contact:
Approved ,20 Mail to:
Disapproved a/c
Phone:
Expiration ,20 ��
------ f I Building Inspector
APPLICATION FOR BUILDING PERMIT
Nov - g 2015
Date�/�' , 20�
INSTRUCTIONS
i�This_` ppRcatl4 ompletely 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 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.
(Signa ure of applicant or name, if a corporation)
(Mailing address of ap icant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pllunber or builder
Name of owner of premisesd�vr�
(As on the tax roll or latest deed)
If applicant is a corporation,signature.of duly authorized officer
• ,y•1rf� r
(Name and title of"corp;:y &ate officer)
qJ
Builders License No.c, VZV
Plumbers License No. Z34/5�,� &I P
Electricians License No. � fR'
Other Trade's License No.
1. Location of Ian on which proposed work will be ne:
House Number Street Hamlet
County Tax Map No. 1000 Section Block lis Lot �,'
Subdivision Filed 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
p Y /�lea>,t �CZ E di�r�i
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal' Demolition Other Work Zrot
(Description)
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 any: Front_—& y Rear 79' d Depth 1,f-//
Height Number of Stories
Dimensions of same structure with alterations or additions: Front ?.V"4' Rear 7S
Depth t-{4/ "' Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories 2
9. Size of lot: Front 15-d Rear /5�) Depth L�
10. Date of Purchase �201d Name of Former Owner �
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO'r Will excess fill be removed from premises? YES NO \4
✓/ c y 3j-,esf e:G
14. Names of Owner of premises ��,
/ dl,f e.//�� Address/yjs ,��,�� &&wL,Fhone No. (3/ 239' /Do0.1
Name of Architect Address Phone No
Name of Contracto 7d";; Address e`HZL phone No. ;LG lr3f 3/7�
15 a. Is this property within 100 feet of a 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 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 N0__)d
* 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,
CONNIE D.BUNCH
(S)He is the Notary 1Pdup1��1 of w Y
wk
o.(Contractor, Agent, Corporate Officer, etc.) QusNfM In Suffolk County
Commission Expires April
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
perfonned in the manner set forth in the application filed therewith.
t.
Sw o before me this Jj
day of NinV?� 6A 20J Z57
Notary Public ignature of Applicant
i
i
Of SO�jyo �
Town 'Hall Annex y � roP �V61
892
54375 Main Road 65lto aW( 37
D
P.O.Box 1179 e IOso
jnv.0
Southold,NY 11971-0959
BUILDING DEPT
BUaDING DEPARTMENT 'OWN OF SOU MO
TOWN OF SOUTHOLD j
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: ` wqe� Date:
Company Name:
Name:
License No.:
Address: l
' Phone No.: -
:
JOBSITE INFORMATION: (*Indicates required information)
*Name: d
*Address:
*Cross Street: 95
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: Block: Lot:
E
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) f
(Please Circle All That Apply)
*Is job ready for inspection: YE / NO Rough In
*Do you need a Temp Certificate: YES!`&
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 00 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form
�7
soUry®l -
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Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G • Q
Southold,NY 11971-0959 �® a
lycOUNT`0,��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
July 29, 2016
Donna Wexler
1775 Indian Neck Lane
Peconic, New York 11958
TO WHOM IT MAY CONCERN:
The items marked below are required to obtain your Certificate of Occupancy.
Application for Certificate of Occupancy. (Enclosed)
# Electrical Underwriters Certificate.
A fee of$50.00.
Final Survey with Health Department Approval.
41 Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84)
Trustees Certificate of Compliance. (Town Trustees#765-1892)
Final Planning Board Approval. (Planning#765-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept.
Final Storm Water Runoff Approval from Town Engineer
BUILDING PERMIT: 40273-Z alterations
® : SOUNDINGS FEET BELOW ALN. 1775 INDIAN NECK LANE
DATUM ALW.- 0.0' ♦A,p �
SURVEYOF PROPERTY NEW PILES 6'pJ BY zD' CCA, ®
A T PECONIC NEW NEW DECKN
NFIR"A` LUMBER ACO OR EQUAL®
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y. ANG
1000-86-05-9.1
SCALE.- 1 - 60 �\ �� 4F KEY AIM
SEPTEMBER 21, 2011 Tp ` �o }612 44 q�� SCALE. : iaao' y\
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LOT NO.s REFER TO MINOR SUBDIVISION FDR -, 4 N. YS. LIC. N0. 49618
PECONIC BAY GARDENS INC." FILED IN THEA
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OFFICE OF THE SOU7HOLD TOWN CLERK. 'C�, 4 ���°' � : CONIC VEYORS, P.C.---
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SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. � tA�;O �)I ' 631 765-5020 FAX 631 765-1797
r� EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS FLOOD ZONE LINES FROM 36103C0162H
HEREON ARE VALID FOR THIS MAP AND COPIES 7HEREOF ONLY IF AND ACTUAL FIELD INFORMATION P.O. BOX 909
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF 7HE SURVEYOR 1230 TRAVELER STREET
WHOSE SIGNATURE APPEARS HEREON. ELEVATIONS ARE REFERENCED TO NVGD. SOUTHOLD, N. Y. 11971 ��-133
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Design Services
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L. tion: Suffolk County,New York
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BATH 1 I Pacanic,NY michael@mchdesignservices.co
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