HomeMy WebLinkAbout42571-Z ��o��UFFOI,fCaGy Town of Southold 7/30/2018
P.O.Box 1179
a
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39805 Date: 7/30/2018
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 3100 Akerly Pond Lane, Southold
SCTM#: 473889 Sec/Block/Lot: 69.-3-2.3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/10/2018 pursuant to which Building Permit No. 42571 dated 4/16/2018
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"ALTERATIONS TO AN EXISTING ACCESSORY BARN AS APPLIED FOR
The certificate is issued to TCG3 LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42571 07-19-2018
PLUMBERS CERTIFICATION DATED
A oriz I ture
�S�FFotK TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 42571 Date: 4/16/2018
Permission is hereby granted to:
Szczotka, Barbara & Theodore
190 North Rd
Peconic, NY 11958
To: legalize "as built" alterations to an existing accessory barn as applied for. Additional
certifications will be required.
At premises located at:
3100 Akerly Pond Lane, Southold
SCTM # 473889
Sec/Block/Lot# 69.-3-2.3
Pursuant to application dated 4/10/2018 and approved by the Building Inspector.
To expire on 10/16/2019.
Fees:
AS BUILT-ACCESSORY $200.00
CO -ACCESSORY BUILDING $50.00
otal: $250.00
Building Inspe or
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:
I 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:
I 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
I. 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. aj
New Construction. Old or Pre-existing Building: (check one)
Location of Property. :55/ 6dj)l ��
) /np
House No. Strl6et Hamlet
Owner or Owners of Property-
Suffolk County Tax Map No 1000, Section Block � _ Lot 1 3
Subdivision 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: $
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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 01
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1447 `I1
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To- TCG3 LLC (Szczotka)
Address: 3100 Ackerly Pond Lane city,Southold st: New York zip: 11971
Building Permit#: 42571 Section: 69 Block: 3 Lot: 2.3
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Ron Fetter Electric License No: 40968-ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 24 Ceiling Fixtures 12 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 8 Wall Fixtures 5 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks
Disconnect Switches 2 Twist Lock Exit Fixtures TVSS
Other Equipment: "BARN"
Notes: 5- Exit/ Emergency Lights
Inspector Signature: Date: July 19, 2018
0-Cert Electrical Compliance Form.xis
SOUTyo
TOWN OF SOUTHOLD BUILDING DEPT.
CO 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION-2ND [ ] I ULATION
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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DATE INSPECTOR
OF SOUIy��
# TOWN OF SOUTHOLD BUILDING DEPT.
couMv��' 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] 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:
V-7
DATE INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(1ST) H
----------------------------- -------
'FOUNDATION (2ND)
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ROUGH FRAMING&
PLUMBING y
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INSULATION PER N.Y: H
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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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 r / Suryey
SoutholdTown.NorthFork.net PERMIT NO. 2 Y Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined ,20 Storm-Water Assessment Form
♦� tY Contact:
Approved r ,201
Mail to:
Disapproved a/c 2A5_' 0
P :hone
Expiration O Q 20�
Building Inspee
APPLICATION FOR BUILDING PERMIT
Date , 20 /�S
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 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
Reg o Idings, additions, or alterations or for removal or demolition as herein described. The
aPP ary 1 P icable laws, ordinances,building code, housing code, and regulations, and
auth ori d inspectors on,premises, building for necessary inspections. g to admit
SPR 1 0 2018
gnature f ap name,if a corp( a ion)
TOWN OF SOUTHOLD =� C
(Mailing it r ss of applicant)
State whether applicant is owner, lessee agerit, rchitect, ngineer, general contractor, electrician, plumber or builder
/ V
Name of owner of premises
(As on the x roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders LicenseN � 1��r I nA La
Plumbers License No. 1 n „
Electricians License No.
Other Trade's License No.
1. Location of land on whi h proposed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section Block_L')_3_Lot 2.
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 occupancyL%�^y� �
b. Intended use and occupancy
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal _Demolition Other Work
(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 . 11
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front 10 Rear �(p , .Depth
Height' Number of Stories' /
1Y
Dimensions of same structure with alterations or additions: Front (n(n,l Rear
Depth ,d Height 3�/iNumber of Stories /
8. Dimensions of entire new construction: Front '094 i's— Rear 554—, 2-1 Depth /,3& ,69
Height ,Number of Stories
9. Size of lot: Front 15� a / I Rear_ 5�5
4 2/ Depth 122 0'de
10. Date of Purchase l Name of Former Owner- ��4 ,�--���
11. Zone or use district in which premises are situated L�/
12. 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 from premises? YES NO
14. Names of Owner of remisesT Address hone No. 67(e•e'12
Name of Architect 16r&MM Alk— Address Phone No19]�J- :77' 75-.)'
Name of Contractor Address V 1 1 Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES. -.-.Nr), .,..
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. s
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.
3' '
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
* IF YES, PROVIDE A COPY.
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,state of Now York
No.01 BU6185050
SS: QuaNfied in Suffolk County
COUNTY OFcommission Expires April 14,2
c being duly sworn, deposes and says that(s)he is the appiicant
(Name U individual signing contract) above named,
(S)He is the a�- CaLa�k/ L&X,�w &Jnt�
(Contractor,(!511 rporate 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.
jS om, g before mejthni r
c�day o 20 f
V
Notary Public Sig re ant /
Scott A. Russell
SUPERVISOR � �
z AMIA\- A�G]EM[]E1�'7[�
SOUTHOLD TOWN HALL-P.O.Box 1179 0
53095 Main Road-SOUTHOLD,NEW YORK 11971 'toy Town of Southold
r
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWHHG: I
j (CHECK ALL THAT APPLY)
Yes No
❑ A. Clearing, grubbing, grading or stripping of land which affects more �I
than 5,000 square feet of ground surface.
❑ B, Excavation or filling involving more than 200 cubic yards of material II�
within any parcel or any contiguous area.
I�
EIQ C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance, I
❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal I�
erosion hazard area.
❑ E. Site preparation within the one-hundred-year floodplain as depicted
it
on FIRM Map of any watercourse. ;
❑ F. Installation of new or resurfaced impervious surfaces of 1,000 square i
feet or more, unless prior approval of a Stormwater Management
Control Plan was received by the Town and the proposal includes I
+ in-kind replacement of impervious surfaces. I
If you answered NO to all of the questions above, STOP I Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building Department w!tfi your Building Permit Application.
(--`....... .�::-. .. ... ..... .. .. ...... . .....__ ._ S.C'.T.M. 1000 Date.
APPLICANT• (Property Ownei,Design Professlona,Agent, ntractot,Other) Distract
I'
N Section Bloc Lot
j S� r
** FOR BUILDING DEPARTI\ NT USE ONLY `*
Contact Infoimahon1, 62 F-7 -7 D�2__ I II
lTekyhone bomb.. ;
Reviewed By:
;l
i Date: / —
i _Property Address /Location of Construction Work: i _ — _ _ _ _ _ _ _ _ _ _ j
i Approved for processing Building Permit.
1 ; — _ Stormwater Management Control Plan Not Regwled. 11
— !j
Stormwater Management Control Plan is Requued.
_ , D
i (Forward to Engineer tng Depat Unent for Revte" )
FORM * SMCP-TOS MAY 2014
7--,/ S- /Jl-
$Uff��C BUILDING DEPARTMENT- Electrical Inspector
�O TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
o Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
1 roger.richert(cb-town.southold.ny.us
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: _ C. - - Date: I -
Company Name: E
Name:
License No.: email: ,o f 'Fag
P
Address: ZL p COil
Phone No.:
JOB SITE INFORMATION: (All Information Required)
Name:
Address: �-
Cross Street:
Phone No.: 7 Z -7 '
Bldg.Permit#: G/ 2 7 ( email:
Tax Map District: 1000 Section: Block: Lot: Z�
BRIEF DESCRIP ON OF WORK (Please Print Clearly)
Circle All That Apply:
Is job ready for inspection?: YES /0O Rough In Final
Do you need a Temp Certificate?: YES / Fl0 Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A # Meters Old Meterff
New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
MENT DUE-WITH APPLICATION
MAY 1 4 2018 BUELDING DEFT. X
Request FOM" � i�®�
�SUFFokx-
Town Hall Annex ^�� y�`'� Telephone(631-1802
54375 Main Road Fax(631) 734-9502
P. O Box 1179 0� z ,
Southold, NY 11971-0959 �- "� •)
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION, PRE-ENGINEERED
WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION
Date: 4A
Owner:
Location of Property:
Please take notice that the (check applicable line):
New'residential structure
Addition to existing residential s(ructt.ire
Rehabilitation to an existing residential structure
to be constructed or. perfvrmEd at the subject propertFence above will citilize
(check applicable line):
Truss type construction (TT)
Pre-engineered wood construction(PW)
_ Timber construction (TC)
in the following iocation(s) (check applicable line):
Floor framing, including girders and beams (F)
Roof framing (R)
Floor and roof framing (FR)
Signature:
Name (person submitting this form):
Capacity(check applicable line):
Owner
Owner representative
TrussResRegI5.docx Effective 1112015
6" DIAMETER
EFLECTIVE RED ROMAN ALPHANUTOERIC
----'-'DESiGNAT-ION-OF CONTS T iZUCT ION -
(PMS) 9187 TYPE BASED ON SECTION 602 OF
THE BUILDING CODE OF NEW
YORK STATE
2" MIDI_ REFLECTIVE
WHITE
112" S I ROCK :' '.'•', .. ;
--- .. -._ .._ •D�S�,Cybl�i'ILPON'f''O�'Sj7'R(�C7`[tftltt � •-- -._.__.— __._...,.-----•--- • '- ---
CdMP'0NENTS THXT ARS•OF
TRUSS CONSTRUCTION
"F" FLOOR FRAMING, 1N,CLUDIIIG
GIRDERSIAW13 BEA 49---,l •
-'R'' ROOF PRAM1tQG
-FR" FLOOR AND ROOF O6iA 416G .
TRUSS IDES.. TR ATI.ON•SIGN
JANCE'\MTH 19'WCRRPART':12Ei,S44.q�
--'. E)gVVPLE TRUSS IDENMCaMON SIGN DATE:03(08 2DW
NEW YORK STATE DEPARTMENT OF STAT-E
DIVISION OF CODE ENFORCEMENT
AND ADMINISTRATION
EN�,p�`ri(ic:
ROBERT I. BROWN, ARCHITECT P.C.
205 BAY AVENUE GREENPORT, NY 11944
631-477-9752 FAX 631-477-0973
info ribrownarchitect.coin
Transmittal
Date: May 30, 2018
To: Southold Building Department
Re: TCG3, LLC
3100 Ackerly Pond Lane
Enclosed please find revised "as-built" drawings.
Thank you,
D CCC ��If
Karen Szczotka M AY 3 0 2018
Agent for
Robert I. Brown Architect, PC B ,DING D-HI'M
karen@ribrownarchitect.com TOWN OF SOUTHOLD
oF soUry®l
� o
Town Hall Annex Telephone(631)765-1802
54375 Main Road y 41W Fax(631)765-9502
P.O.Box 1179 G •
Southold,NY 11971-0959 'Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
June 27, 2018
TCG3 LLC
41900 Route 25
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. (Electrical Inspector 631-765-1802)
A fee of$50.00.
Final Survey with Health Department Approval.
Plumbers Solder Certificate
Trustees Certificate of Compliance. (Town Trustees#765-1892)
Final Planning Board Approval. (Planning#765-1938)
Final Fire Inspection from Fire Marshall. (631-765-1802)
Final Landmark Preservation approval.
Final Elevation Certificate required.
Final Storm Water Runoff Approval from Town Engineer
BUILDING PERMIT: 42571-Z alterations to barn
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SURVEY OF PROPERTY
f ° SITUATF,
SOUTHOLD
TOWN OF SOUTHOLD
W �S2—°Q�f SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-69-03-2.3
SCALE 1"=50'
4 �•�,�trr NOVEMBER 28, 2017
^I : Z SCALE
° I e,n NO�� JpAs N AREA = 106,375 sq. ft.
2.442 ac.
CERTI, ,D TO:
TCG3, LLC
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RAkE BggN �•� CHICAGO TITLE INSURANCE SERVICES, LLC
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IND. 50467
TO THIS SURVEY
ALTERATION TI ADDITION /y• E°•
r TO THIS SURVEY IS A VIOL ATION O� -V f ° �
Nathan Taft c-orwin III SECTION 7209 OF THE NEW YORK STATE (/^ TIS �
Land Surveyor EDUCATION LAW
COPIES OF THIS SURVEY MAP NOT BEARING _i
THE LAND SURVEYORS INKED SEAL OR J
EMROSSFD SFAI 5HAI I NOT RE CONSIDERED P p j) ~ UIIe
TO BF A VALID TRUE COPY f 1 V•(J (T ^ �•Y Z94
CERTIFICATIONS INDICATED HEREON SHALL RUN v1`jl\I tl `• `OnC,�frfN
SuccessOr To. Stanley J. Isaksen, Jr, LS. ONLY TO THE PERSON FOR WHOM THE SURVEY 1 YYY• 1 '�' D,r
Joseph A Ingegno t$, IS PREPARED,AND ON HIS BEHALF TO THE l
TIRE COMPANY, GOVERNMENTAL AGENCY AND
Title Surveys - Subdivisions - Site Plans - Construction Layout LENDING INSTITUTION LISTED HEREON,AND '
TO THE ASSIGNEES OF THE LENDING INSTI-
PHONE (631)727-2090 Fox (631727-1727 TUTION CERTIFICATIONS ARE NOT TRANSFERABLE
OFFICES LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHT OF WAYS �
1586 Main Rood P.0 Box 16 AND/OR EASEMENTS OF RECORD;IF
Jomesport, New York 11947 Jamesport, New York 11947 ANY, NOT SHOWN ARE NOT GUARANTEED.
ISSUES/ REVISIONS
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`b1 > •)URED CONCRETE
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Ar 'a .6. ryo e�p1 C , I G"x IG" 2x 10 RAFTERS @ ISG'O.C. 05 APRIL, 2018
� ti o s CONCRETE EXISTING
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