Loading...
HomeMy WebLinkAbout28440-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29392 Date: 04/25/03 T~IS CERTIFIES that the building ADDITIONS & ALTERATIONS Location of Property: 1710 PIKE ST (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 140 Block 3 Su]~division Filed Map No. Lot No. FLATTITUCK (HAMLET) LOt 19.1 conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 5, 2002 pursuant to which Building Permit No. 28440-Z dated JUNE 5, 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 ADDITIONS & ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to KATHRYN H ROSE of the aforesaid building. ( OWNER ) SUFFOLK COUN~"f DEPARTMENT OF ~LT~ APPROVAL R10-02-0090 04/14/03 ELR~-£~IC~L CERTIFIC_AT~ NO. 1099767 01/10/03 PLUMBERS CERTIFICATION DAT~U3 02/05/03 MATTITUCK PLUMB.& HEAT. ~~~'~gna t u r e 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. 28440 Z Date JUNE 5, 2002 Permission is hereby granted to: KATHRYN H ROSE PO BOX 12 MATTITUCK,NY 11952 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 1710 PIKE ST County Tax Map No. 473889 Section 140 pursuant to application dated J73NE Building Inspector to expire on DECEMBER Fee $ 150.00 Block 0003 MATTITUCK Lot No. 019.001 5, 2002 and approved by the 5, 2003 . COPY Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL This application must be filled in by typewriter or ink and submilted to the Building Department with the'"i~%wi~: ~/ Ao 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. Bo For existing buildings (prior to April 9, 1957) hon-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. Co Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $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 o f Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision PermitNo. 2.~?9tt/g) --7~- DateofPermit, Health Dept. Approval: ~'~ Planning Board Approval., Request for: Temporary Certificate Fee Submitted: $ Old or Pre-existing Building: Street Date. J (check one), Hamlet Block O~ Lot Filed Map. Lot: /D Z Applicant: Underwriters Approval: Final Certificate: (check one) Q,,~ Apphcant S~gnamre BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD Of FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NeW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by REP ELECTRIC P.O. BOX 635 MATTITUCK, NY 11952, KATHRYN ROSE 1710 PIkE STREET MATTITUCK, NY 11952 Located at 1710 PIKE STREET MATTITUCK, NY 11952 Application Number: 1099767 Certificate Number: 1099767 Section: Block: Lot: Building Permit: BDC: NS11 28440Z Described as a Residemial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, Outside, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found to be in compliance therewith on the Name Alarm and Emergency Equipment Sensor Sensor Wiring and Devices Receptacle Switch Fixture Paddle Fan Receptacle 10th Day of January, 2003. QTY Rate Rating Circuit Type 1 0 Carbon Monoxide 2 0 Smoke 7 0 General Purpose 4 0 General Purpose 5 0 Incandescent 1 0 1 0 GFCI seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: Building Permit No. Owner:__ ~"~r ~M~e-j/~ (Please print) ' (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Swom to before me this ~ dayof ~/-g~tM,c/ , 20~9,..~ Notary Public,/~.,~ County 8o. 01 ~~ Term ~ BUILDING PERMIT EXAMINER CHECK LIST APPLICANT: ~-~r~ SCTM# DISTRICT: 1,000, SECTION: STREET ADDRESS: 17/0 r~tc~ ~V. PROJECT DESCRIPTION: ESTIMXTED PROJECT COST: , BLOCK: ~ , LOT: DATE 1S~SUED: / /02 DATE REVIEWED: ~/~ /02 DATI~'SUBMITTED: Z~/~/02 CITY: ~q ~W~ TIJO(-_ SUBDIVISION: '~'--. · ~/ENG1NEER.'~4 FAST TRACK? SiNGLE & SEPARATE CERTWICATiON-REQUIRED? ~o NOTES: ~-- LOTS 40,000SF -100-24. Lot recognition(CREATED bel3re June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25 Merger (A nonconibrming at any time after 7/I/83) ZONING DISTRICT: ~t~O CONFORMING? /~ _ REQ. LOT SIZE: ~0/l~'t2 ACT. LOT SIZE:~,. ~O" REQ. LOT COV. REQ. FRONT ~- PROP. FRONT,91~ REQ SIDE REQ. REAR ,.~' PROP. REAR ~ WATERFRONT? /~ DESCRIPTION:~'*~ PANEL #: ,~/t FLOOD ZONE: ,1/ , ..~,~ ACT. LOT COV. J~ ACT. SIDE 4f~fi",/ APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT:(~r NO, (BED #): ~t~ DTE:~4~/~/ /~_ PERMIT #:R10- ly_~- ~'~ TOWN SEPTIC RECE~T:~or N NEW YORK STATE DEC: ea~-o~c 9a/vs YES or SOUTHOLD TOWN TRUSTEES: YES or~) TOWN ZONING BOARD APPROVAL: YES TOWN PLAN. BOARD APPROVAL: YES or~ TOWN HISTORICAL PRE (SPLIA): YES NYS ENERGY: YES OR ~ : EGRESS (18 H min.? 4 sq total) __ VENT (SQ. FT. x 4%). LIGHT (SQ. FT. x 8%). BUILDING PERMITS OPEN/EXPIRED: BP HAVE PRE CO'S: Y ORN BP/IOd [ -Z / C/0 NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: ,~oQ SF SECOND FLOOR: SF OTHER: SF TOTAL: ~:~.,-.,-.,-.,-.,-.,~ SF 1. ( ~'a,q SF)- ( SF)= SF X $__ 2.( SF)-( .SF)= SF X $ INIT OTHER FEE FEE +$ +$ +$ +$ =$ =$ TOTAL FEE Town Of Southold P.O Box 1179 Southold, NY 11971 (631) 765-1800 RECEIPT #2933 06~05/2002 Rose, Katherine Po Box 12 1710 Pike Street Mattituck, NY 11952 Received $10.00 for Septic Permit - Construct - Resid., on 06/04/2002. Thank you for stopping by the Town Clerk's office. As always, it is our pleasure to serve you. Neville Clerk Elizabeth A. Southold Town 765-1802 BUILDING DEPT. [ ~FOUNDATION 1ST INSPECTION FOUNDATION 2ND FRAMING FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL DATE INSPECTOR 765-1~02 BUILDING DEPT. INSPECTION [ ]/~NDATION 1ST [ ~]' FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL REMARKS: ...~"~ CC~ c~/ : INSPECTOR 765-~,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] ROUGH PLBG. [ ~/INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ v~J' ROUGH PLBG. ] F/OuI~DATION 2ND [ ]INSULATION / FRAMING [ ] FINAL FIREPLACE & CHIMNEY REMA.KS. /C~~~. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INS~JiJtTION [ ~NAL DATE INSPECTOR DATE COlmVlI~ FOUNDATION (IST) F OLVNDATION (2ND) ROUGH 1NSUI~ATION PER N. ¥. STATE ENERGY CODE F1N~L ADDITIONAL CO1?IMIiN'~ 7~ ..~? -.7 TO'WN O'F SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 _,20_ Approved / ~____, 20 Disapproved a/c Exp/ration~/~____, 20~ ~ - BUILDING PERMIT APPLICATION C'HECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval__ Survey. Check Septic Form N.Y.S.D.E.C. Tmst~es Contact: Mail w: Phone: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ,20oZ- a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 pror~rty have been enacted in the inte~an, the Building Inspector amy authorize, in writing, the cxtcnsion 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 Bui!dmg 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 a6mit authorized inspectors on premises and in building for necessary inspections. e of applicant or name, if a corporation) (M~iling address of applicant) State whether applicant is owner, lessee,~gent)architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ',.~'/~t/~o~e~ ff. RaS 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. ~3, Z Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land_on which proposed work will be done: 17/ P k e _.qr- House Number Street County Tax Map No. 1000 Section Subdivision (Name) Hamlet Block O .~ ~ Lot Filed Map No. Lot Iq./ 2. State existing use and occupancy of premises and~ntended use and occtjpancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition ~ Alteration Repair Removal Demolition Other Work 4. Estimated Cost ~t4dO0 . 5. If dwelling, number of dwelling units If garage, number of cam Fee (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 7.3,__~__~Rear 7.5.7 Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front ~(q' ? Depth ~Z ' Height. Number of Stories 8.-Dimensions of entire new construction: Front /~ Rear /~, Depth Height Number of Stories tffa.. /5'/, L.,,' Depth 9. Size oflot: Front [2fi' ~ ~ 10. DateofPurchase [ ~ ~f~ 7 · Name of Former Owner ..~ ~tr Rear 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zo.~,~g law, ordinance or regulation7 YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES 14. NamesofOwnerofpremises ~",~/'74,e,ff,~/ ~..~ Address /¢/~ ~A~'~r PhoneNo. NameofArchitect ]5,,q~*~ ~'.~4t~.-~'o~, Address t~, t&l~! F4~,q~,t--PhoneNo Name of Contraetor .Jo~/ ~,*J~ Address ~t /,,ff LA~t.~-~- PhoneNo. 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. 1 6. 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. STATE OF NEW YORK) SS: COUNTY OF ) J O-/"/.d ~ ~lp.~ being duly sworn, deposeg~ and sa~'s that (s)he is the applicant (Na.,me of individual signing contract) above named, (S)He is the ~ O,~, (Contva6tor', 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. ~Si~atur~ of Applicant I TEST HOLE DONE BT MCDONALD CEO$OIENDE ON 24 APRIL 2002 ORIOINAL OROUND +150' TO CESSPOOLS 102' TO WELL TIE DISTANCE 490.36' CESSPOOL © RI? GREENBERG DARK BROWN SANDY LOAM OL 1' BROWN LOAMY SAND SM 3.5' PALE BROWN FINE TO MEDIUM SAND SP CESSPOOLS WELL 150' 120' IPIKE L STREET N 74'22'00"El PROP. WELL COVERED STOOP HOLE TION 2-STORY WOOD FRAME RESIDENCE SCREENED PORCH S 75'52'30"W N/F MASSEY NO WELLS OR CESSPOOLS WITHIN 150' OF PROPERTY LINE IN THIS AREA 155.39' 2-CAR GARAGE EX/STING SANITARY IN THIS AREA TO BE PUMPED AND BACKFILLED 157..25' MA T~TUCK HIGH A THLE~£ F/ELD +150' TO WELLS OR CESSPOOLS WELL O N/F ZAHRA © ) CESSPOoLs 0 17' TM# 1000 140-05-19 1 GUARANTEED TO: KATHRYN H ROSE FOR SCDHS USE ONLY SURVEYED: 7 MARCH 2002 SCALE 1"'- AREA - 18,904.90 SF. OR 0434 ACRES SURVEY OF DESCRIBED PROPERTY SITUATE MATI-ITUCK, TOWN OF SOUTHOLD SUFFOLK COUNI'Y, N.Y. SURVEYED FOR: KATHRYN H. ROSE SURVEYED BY " STANLEY d. ISAKSEN, JR: : P.O. BOX 294- NEW SUFFOLK. N.Y. 1t956 ~ , 631 734-5835 02R1 1. 17 Moy 02 correct Easterly PL 10 102' TO WELL +150' TO CESSPOOLS CESSPOOL TEST HOLE DONE BY ~,----- MCDONALD GEOSCIENCE ON 24 APRIL 2002 ORIGINAL GROUND DARK BROWN SANDY LOAM OL BROWN LOAMY SAND SM PALE BROWN FINE TO MEDIUM SAND SP 74'22'0( CESSPOOLS 150' WELL 120' STREET NEW WELL ?EST HOLE LOCATION 2-STORY WOOD FRAME RESIDENCE SCREENED PORCH NEW SEPtiC NEW S 75'52'30"W N/£ M^SSEY NO WELLS OR CESSPOOLS WITHIN 150" OF PROPERI~ UNE, IN THIS AREA 15339' 2-CAR GARAGE 151_23' MA TTITUCK HIGH SCHOOL ATHLETIC F/ELD +150' TO WELLS OR CESSPOOLS 0 N/F ZAHRA 0 OCESSPOOLS 0 1000-140 03-19.1 GUARANTEED TO: KATHRYN H, ROSE FOR SCDHS USE ONLY SURVEYED: 7 MARCH 2002 SCALE 1"'= 50' AREA = 18,904.90 OR 0,454 ACRES SURVEY OF DESCRIBED PROPERTY SITUATE MATF/TUCK, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: KATHRYN H. ROSE - ~ SURVEYED BY ~- STANLEY d. ISAKSE'N, dR. u~ P.O. BOX 294 · NEW SUFFOLK. N.Y. 11956 ) , JuL r 02 ADD POUREO CONDRET~ EOUNOA r/o~?~F~-Tf,4~-b ~5~CFCo~ Ney 02 correct Eosterly PL, 02R1110