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43073-Z
Town of Southold 11/27/2018 P.O. Box 1179 53095 Main Rd # Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40064 Date: 11/27/2018 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 275 Wilson Rd., Cutchogue SCTM#: 473889 Sec/Block/Lot: 103.-9-6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/18/2018 pursuant to which Building Permit No. 43073 dated 9/27/2018 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"ADDITIONS AND ALTERATIONS INCLUDING FINISHED SECOND FLOOR AND ENCLOSED PORCH TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Bergen,David of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ut Ted Signature ��ffol� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY �'>7zxuaf 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#: 43073 Date: 9/27/2018 Permission is hereby granted to: Bergen, David PO BOX 1008 Cutchogue, NY 11935 To: additions and alterations to an existing dwelling as applied for. At premises located at: 275 Wilson Rd., Cutchogue SCTM # 473889 Sec/Block/Lot# 103.-9-6 Pursuant to application dated 9/18/2018 and approved by the Building Inspector. To expire on 3/28/2020. Fees: AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $400.00 CO -ADDITION TO DWELLING $50.00 Total: $450.00 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%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. all I % / I $ New Construction: Old or Pre-existing Building: ✓ (check one) Location of Property: '�-7 5 W c,S a N R.a,k b C v T C f4 0 4 u C House No Street Hamlet Owner or Owners of Property: DAV I D ( SMCI CW Suffolk County Tax Map No 1000, Section l 03 Block 9 Lot (p 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: $ Applicant Signature Mr Robert Barratt PE, 4295 Vanston Road, Cutchogue, NY 11935 Tel 631 734 2730 Email Southold Building Dept. Southold NY, Delivered by hand Subject: 275 Wilson Avenue, Cutchogue, NY 11935 Gentlemen, I have inspected the second floor bedrooms and the enclosed porch at the subject address and my findings are as follows: The house was built by Beebe a well-known local builder. His practice in those days was to build houses with the second floor bedrooms and bathroom partially finished, ready for completion at the new owner's request. In this case, the new owner authorized the additional work and my inspection indicates that to the best of my knowledge, the two second floor bedrooms and bathroom were completed in accordance with the prevailing code of that time. Subsequently the owner decided to convert the open concrete patio into an enclosed porch so she could fully enjoy her summer days outside in the fresh air. This work, in my opinion, has also been completed in a thoroughly professional manner. .For your convenience I am attaching a drawing showing the current house floor plans Yours sincerely, CO o BAR w)0 �� o� S� Robert Barratt PE Attachment: st�,o 081 86Z 1) Drawing No 111718 Rev 0 S1ONr '009V /9? c�c�cad� D NOV 1 9 '_',018 RUnDERIG i Erl TOWN OF SOUTHOLD souTyO6 # # TOWN OF SOUTHOLD BUILDING DEPT. Q um, 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATn�ION6(44-- [ ] FRAMING / STRAPPING [ FINAL 41 [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: yCIDX2 Oki lwtNo� 5Q G IS 64T� AkS40-0 rib per r,�f5+fs . DATE D INSPECTOR * * TOWN OF SOUTHOLD BUILDING DEPT. °`"rouxn � 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] RO GH PLBG. [ ] FOUNDATION 2ND [ ] SULA [ ] FRAMING /STRAPPING [ FINA �QQi [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 04 04 toorD 47 DATE INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) W� ------------------------------------ tg 'FOUNDATION (2ND) % ROUGH FRAMING& PLUMBING 1 INSULATION PER N.Y-. STATE ENERGY CODE --� � P � L illy Ell FINAL ADDITIONAL COMMENTS mock/ 'At]!& Oct -� o * z m d O z d b y r FIELD INSPECTION REPORT DATE COMMENTS ►ti FOUNDATION(1ST) . y --------------------------------- 'FOUNDATION -------------------------------'FOUNDATION (2ND) O 1 ROUGH FRAMING& y PLUMBING r. INSULATION PER N.Y: � H STATE ENERGY CODE 0 e 1 "jAwitt oA Lew o, • o FINAL ADDITIONAL CO TS Lf5c),no fp-1- _t§ O Z m S2� III L 10 C3 -w- 1 ' 71 L7 O z d b H 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 119714Dets of Building Plans TEL: (631) 765-1802 Manning Board approval FAX: (631) 765-95022 -Survey Southoldtownny.gov PERMIT NO. ��o-� J Check Septic Form N.Y.S.D.E.C. tees C.O. pplication fJ Flood Permit Examined '20 r�� V Single&Separate DTruss Identification Form SEP 1 8 2018 Storm-Water Assessment Form —7 /� Contact: Approved ,Z 20 Mail to- F—OMETZ-r 36A.iLA.A- T Disapproved a/c "j n� 4-2q S VA N VT D lJ P-0 Phone- 41-OTC-e+04; Q 1 /Vy !1935 Expiration ,20 �'�I—`134 Building Inspec r APPLICATION FOR BUILDING MIT 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 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. el�l (Signature of applicant or name,if a corporation) 4295 vans-rz-,,J (7vTG ,4oc,y6 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architec , engineer general contractor, electrician, plumber or builder Name of owner of premises Day i it R, $E?-' 4g N (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. N `( P E 4 O 1. Location of land on which proposed work will be done: 2-75 Wit_SoQ 20lXp C"i.JT.0r,, iii House Number Street Hamlet County Tax Map No. 1000 Section 103 Block Lot (o Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructio : a. Existing use and occupancy 3 gE 1> e__0©M HCZIQ s E b. Intended use and occupancy S N,C r—r N t E H, Z^K4 ;C:&ct�' 3. Nature of work(check which applicable): New Building Addition Alteration✓ Repair W I N bo W a Removal Demolition Other Work 6lrTVLa k L STA ti Cks e 9,`=9L4C-1E,U (Description) 4. Estimated Cost c,' 'Fee ' oMpaid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling u ip n each floor If garage, number of cars 6. If business, commercial or mixed occupancy, speciy nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear r Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front So Rear So, Depth 24 Height 2-C) Number of Stories 2- 8. Dimensions of entire new construction: Front 31 Rear 3 Depth d" Height ) s Number of Stories S7AI2C-ASL 9. Size of lot: Front t 1 S Rear � t S Depth 1 9 C=) 10. Date of Purchase S)Ib I"1 I Name of Former Owner 8E.c 6 E 11. Zone or use district in which premises are situated Z-E;-.i T�b Nr 14 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 ✓ A S%% tjA.1AV PT.RD 14. Names of Owner of premises Dav A 4 Address 'D,01 Ric t 00 Ss Phone No. X31-'1 4^ 6_1 1 Q Name of Architect Address CQT c K,0 4 o E Phone No —Name of Contractor Address Phone No. 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. 5 a E ►1�w� H ��pt 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. ELC V NT1 ON Is 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 O&jg Rb(SuLT 13, ae-A 1[` �E. being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the N\4 5 - P E7 (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 th* t+'_1 day 20 7 J ACEY L. D ER Notary Pub c NOTARY PUBLIC,STATE OF NEW YORK Signature of Applicant NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2Q2,2, APPROVED AS NOTED DATE:91Z7/IY B.P.# 'r150—+3:1 FEE � COMPLY WITH ALL CODES OF -�--� BY. �P 2' NEW YORK STATE & TOWN CODES NOTIFY BUILD%G, DEPARTMENT AT AS REQUIRED 765-1502 8 AM TO '; PiJ FOR THE FOLLCI,DING INSPECTiUf,'S• S 1. FOUNDATION - TWO REQUIRED FOR POURED CUivCppE. 2. ROUGH FR:1?d';iiti, & PLUM&Nia VwTOWTOW 3. INSULATION � - 4. FINAL - COJ'SS7 UC T ICN M;)ST BE COMPLETE ALL CONSTRUCTICN: S�l;ai_L MEET THE REQUIREMENTS OF 'FHL:CODES OF NEW YORK STATE. NOT RESPONSIBLE FORS O � DESIGN OR CONSTRUCTION ERRORS. j UNLAWFUL `'A Additional 'f1 ROUT CERTIFICATE Ad OF OCCUPANCY Certification May Be Required. 7,r.,' C-13VANO jjA ' MW yjq,,,l,--",.) 83GOD L"i 'V(iT .9, 3 rA'rtP-. 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G IC IT +C H am 1z4 W BUILDING M G V 1;;,G Roo 1,00 rOWN OF SOUTHO D S t33 52 Bsoa Qo o mns 310 t BATH%*oraS '7% SE'[aND ��it. SNa.o D TEsl- mace A7° G"RAaE PoRcH - j, Top soy -'�� l.ao r►M k L!JA GIS �AaQ wap.. 4tcw,v�R, g f —iL LIrt FI F.ST FLU*W;, s aAsaM�.�rs � S-ITe PfIGTo1..00ic.Iw; SovTH --CAkfir oF' RIZ. _ OF NEW yo �•�P O. gq .Q� FuonR PLANS AS of a 18/18 REv 4 O�� 'QQ� AOpRE�s : 'YTS WILSON AVE. •- CUTC N,0�iue (1 515 Robert Barratt PE,4295 Vanriton Road,Cutchogue. NY 11935. Tel 63187'5 UZ75 robertbanratt@optonTme-net 2 081865 ��� These plans are an instniment of the service and are the property of the P� F SON design professional whose seal is afked herz Wringemerrts will be Prosecuted to the MUest eAentof the law Gontrsctor shag verify all field Il�,ov!¢, tat P cond"Itians and dimensions and be solely responsible for held fit. The design Professional asswnes no fiabBitjf for omissions due to cutlmown or lunforeseen field conditions and or additions based upon comments not form*acl±nowledged as revisions to these'plans.