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Home My WebLink About29144-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29653 Date: 08/21/03 T~IS CERTIFIES that the building ALTERATIONS Location of Property: 1370 LATHAM LA ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax ~4ap No. 473889 Section 15 Block 9 Lot 1.4 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 9, 2003 pursuant to which Building Permit No. 29144-Z dated FEBRUARY 13, 2003 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 ALTEP~ATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ANDREW R MARTIN & AN0 (OWNER) of the aforesaid building. SUFFOLK COUNTY DHPANTMENT OF ~EALTH APPRO~-AL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'~'~U3 Rev. 1/81 N/A 1112839 08/04/03 N/A FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29144 Z Date FEBRUARY 13, 2003 Permission is hereby granted to: ANDREW R MARTIN 200 HICKS STREET #6-S BROOKLYN,NY 11201 for ALTERATIONS TO A_N EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR FLOOD PMT INCLUDED at premises located at 1370 County Tax Map No. 473889 Section 015 pursuant to application dated JANUARY Building Inspector to expire on AUGUST I~ATHAM LA Block 9, 2003 ORIENT 0009 Lot No. 001.004 and approved by the 13, 2004. Fee $ 250.00 / Authorized Signature ORIGINAL Rev. 5/8/02 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 o f 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 App'-oval 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. C. 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 ofOccupancy on Pre-existing Building - $100.00 3. Photocopy of Certificate of Occupancy - $ 0.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Old or Pre-existing Building: Location of Property: House No. Street Owner or Owners o f Property: Suffolk County Tax Map No 1000, Section Subdivision ~ Permit No. ~.~ [ ,~ Health Dept. Approval: Planning Board Approval: '~-~ ~ ~'- Request for: Temporary Certificate Fee Submitted: $ _ ~ S ~ Date. ~/ (check one) Hamlet Block {~(5)D Filed Map. Applicant: ~t~lx/fJ Underwriters Approval: Final Certificate: / (check one) 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 Located at ALAN HUBBARD ELEC. P.O. BOX 2241 126 CLOVER PLACE AQUEBOGUE, NY 11931, 1370 LATHAM LANE ORIENT, NY 11772 ANDREW MARTIN 1370 LACESOME LANE ORIENT, NY 11772 Application Number: 1112839 Certificate Number: 1112839 Section: Block: Lot: Building Permit: BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, 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 Wiring and Devices Receptacle Switch Fixture Fixture Receptacle Dunmers Paddle Fan Receptacle 4th Day of August, 2003. QTY Rate Rating Circuit Type 4 0 Smoke 17 0 2 0 6 0 1 0 I 0 4 0 1 0 2 0 20 amp General Purpose General Purpose Incandescent Fluorescent Laundry GFCI seal 1 of l This certificate may not be altered in any way and is validated only by the presence ota raised seal at the location indicated. ApplicanU Date Owners Nmne: CT~z~/ ,~ f ~ Reviewed: Architecg Date Engineer: ~ Submi,ted: _~ SCTM ~: Lot: Project Single & separate Required cemfica0on: (Yes / No) Project Description: __~ REOUIRED FOR REVIEW Suffolk Coun~ Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation Flood Zone: Permit YES Number Not s. TOWN CLERK OFFICE OF THE TOWN CLERK TOWN OF $OUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board 'of the Town of Southold hereby adopts two (2) new forms to be used under tl~e Flood Oamage Prevent regulations of the Code of the Town of Southold: "Floodplain Developmen.t Permit Application" [FDP(93)], and "Certificate of Compliance for Oevelopment in Special Flood Hazard Area [C/C(93)]. BLDG. TOWN 9 .Southold Town Clerk August 25, 1993 APPLICATION # PAGE I O[ 4 TOWN OF SOUTHOLD FLOODPL,AiN DEVELOPMENT PERMFT ~PL[CA~ON This form is to be tilled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and l. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein_ 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. Thc permit will expir!: if ho work is commenced within six months of issuance. 6_ Applicant is hereby informed that other permits may be required to fulf'dl local, state and federal regulatory requlrcmen~. 7. Applicant hereby glve~ consent to the Local Administrator or his/her repr~entativ¢ to make (¢asonable h~zpecliom~ requlred to vea~ compliance. 8. I, THE APPLIGANT, C~RTIFY THAT ALL STATEMENTS HEREIN AND IN A'I"rACI-hM .EJqTS TO AND ACCURATE. D^ZE 2.//- 0 g. . THIS APPLICATION AR.~ TO ;r~[L3~O~JY.~NQ.~VLEDGE, TRUE SECIION 2: PROPOSED DEWELOPMENT {'To be completed by APPL, ICANW) HAME ADDRESS APPLICANT /~> .~T~'~ '~T~) k-FC/~ 1~ i~ I~- C-w4'L BUILDER ENGINEER pROJECT LOCATION: To avoid delay in proce~ing the appllcatloa, please provide enough information to easily identify the project location. Provide the ~'eet addre.~ lot number or legal description (attach) ~md, out~ide urban areas, the distance to the neaxest intersecting road or well-known landmark. A sketch attached to this application showing Ih¢ project location would be helphd Coo --15- Iq-. FDP(93) APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check all appticablc boxes): A STRUCTU[Lad~ DEVELOPMENT ACTIVTI'¥ ~TRUCTURE TYPE U] Addition Jilt. Alteration [] Relocation [] Demolition [] Replacement ~R~(Residential (1-4 Family) ~'~-St'ff~6 {~ ~ tZ--~.- O ~ [] Residenti~ (More ~ 4 Fmfly) ~ Nou-rcsiden~ (HoodprooFmg7 ~ Yes) ~ ~{~'~ ~i~O0~ ~ CombNed Use ~iden~ & Co~er~) ~ M~ufact~ed (Mob~e) Home (In M~u- factured Home P~k? ~ Y~) ESWIM~TED COST OF PROJECT B. OTHER DEVELOPMEI'EI' ACTIVITIES; C1 F',II ~ I-1 DHIIing [] Grading F1 p..xcaw~ion (l~5~-uc~uraI Development Checked Above) · [] Wat.ercou[_~e Alteration ~w.l.~og Dredging a~d Channel Modifications) [] Drainage Improvementz (lndu~%t~Culvcrt Work) ~ .-.., [] Subdi'~izlon (N~w or ExTanxiou) [] Individual Water or Sewer System [] Other (Please. Specify). After completing SECTION Z, APPLICAJ-FF should submit form to Local Administrator for review. SECTION 3: FLOODPLAIN' DETERMINATION (Fo be completed by LOCAL ADbflNISTRATOR) The proposed development ix located on ~ Panel No. , Dated The Proposed Development: FI Iz N-_Q..T located in a Special Flood Ha2ard Area ('Notify the applicant that the application review iq complete and NO FLOODPI--adH DEVELOPMF2CF P~ IS REQUIRED). FI Iz located ia a Special Flood H:t?ard ~-ea. FIRM zone de.qignation is 100-Year flood elevation at the site ix: Ft. NGVD (MSL) ~ Unavailabl¢ [] The propo.sed development is Iocaled in a floodway FBFM Panel No. Dated U] See Section 4 for additional inslrucrions SIGNED DATE APPLICATION PAGE 3 OF 4 SECTIO~N ,t: ADDITIONAL INFORJMATION REQUIRED (To bc complete~d, bY L~_AL ADMINI~TR,~TOR) Thc apphcam must submit the documents checked below before Ibc appl/cadon can bc processed: [] A site plan showing thc location of all cxSs, ting structures, water bodies, adjaccm roads, lot d~mensions a-nd proposed development. [] Development plans, drawn to scale, and specifications, including where applicable: details for anchoring structure, proposed elevation of lowest floor ([ncludbag basement), types of water resLStant materials used below the Fust floor, detaiLs of floodproofmg of utilJ6es located below thc ftrst floor and details of cnclosmres below thc £trst floor. Also, Subdivision or other development plains (If the subdivision or other developmeut exceeds 50 Lots or 5 acres, whichever is the lesser, the applicant must provide tOO-year flood elevatioh, s if thc), arc not otherwise available). Pla.~ showing the extent ot' watercourse celocatiou and/or landform alterations. Top of new Fdl elevation Ft. NGVD (MSL). FloodprooFmg protection level (non-residential only) Ft.' NG~rD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in a_~ i~crea~e in the height of the 100-year flood. A copy of all data and c~lculations supporting thi~ £mding mu~t also be submitted. [] Other: SECTION S: PERMIT DETERMINATION (To be comoleted ~y LQq;AL ADMIIqlSTRATOR} I have determined that the proposed activity: A~ F1 Is B. EJ Is not in conformance with provisions of Local Law ~__, 19 __. The permit is issued subject to the conditions attached to and made part of thL~ pomit. , DATE If BOX A iS ch¢cge~d, thc Local Administrator may kssu¢ a Development Per'mil upon paymer~t of designated fee. If BOX 13 ili checke~d, the Local Administrator will provide a wxilten summary of d¢ficiencic-s. Applicant may revise and resubmil an application Io the Local Administrator or may request a hearing from the Board o( Appeals APPEALS: Appealed to Board of Appeals? ID Yes [] No Hca.ring date: Appeals Board Dccizlon --- Approved? [] Yes Conditions [] No APPLICATION PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS (To be submitted bv APPLICANT before Certificate of Compliance b issued'} The following information must be provided for project structures. ~ section mint be completed by a registered profe~ional engineer or a licettsed land surveyor (or attach a cert2ficafion to this application). Complete 1 or 2 below. Actual (As-Built) Elevation of the top of ilae lowest floor, iadudlag basement (j~ O~aotal High Hazard Areas. bottom of lowest structural member of the lowest floor, exducllng piling and caimans) is: FT. IqGVD OvlSL). Actual (As-Built) Elevation of floodproo£mg protection FT. NGVD (MSL). NOTE: Any work performed pdor to submittal of the above information b at the rbk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be comuleted bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on irtspection of the project to ensure compliance with the commtm/ty'a local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCrES? [] 'YES [] NO DATE BY DEFICIENCIES? [] YES El NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be comple[ed DY LOCAL ADMINII!;TRATQR~ Certificate of Compliance issued: DATE: BY: Attachment B SAI~PLE CERTIFICATE OF COMPLIA/gCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECLaL FLOOD HAZARD AREA (OV~r/",rER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: Iq NEW BUILDING lq EXISTING' BUILDING U] VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # ,19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIKEMENTS OF LOCAL LAW # , 19__, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUG~G. [[ ] ~~~MNiDNAGTION 2ND ~ATION [ ] FIREPLACE/~CHIMNEY~ REM~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] ROUGHP~I, BG. [ ] FOUNDATION 2ND [ ]~.ATION [ ] FRAMING [~/]~ FINAL [ ] FIREPLACE & CHIMNEY DATE~'~ I NSPECT~~f~ TO~VN OF $CCTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 PERNIIT NO, Approved 20~_ Mail to: Disapproved ~a ~ ~t'//_/~/,9 ~ Phone: BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying ? Board of Health 3 sets of Building Plans Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Building Inspector APPLICATION FOR BUILDING PERMIT ,~ -\ Date .J /q /0'~ ,20OB. - :~-~) INSTRUCTIONS ' / { \ a. Thi~ app~.~t[oa MUST be completely nlled ,n by typewriter or m ink and subnntted to the Bmldmg Inspector with 3 sets of plans, akXZ~'ate 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 a Certificate of Occupancy is issued by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The pplicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admfit uthorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, ifa corporation) (Mailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder me of owner of premises (as on the tax roll or latest deed) pp~cant is a corporation, signature of duly auIilorized officer (Name and title of corporate officer) ' ders License No. ~bers License ~cians License No._ r Trade's License No. ocation of land on which proposed work will be done: ouse Number Street >unty Tax Map No. 1000 Section bdivision L,A, tOD~,5 Eax313- (Name) Hamlet lock ..... Lot _ Filed Map No. ~q O c/, _Lot State existhag uge~and occupancy of premises and intended use and occupancy of proposed constructton,: a. Existing use and occupancy ,~'~G-L.~_.. ~p~Oxtc.'~. D~,)~L.C-lt6~ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 7, ~"O ~). '~' / 5. If dwelling, number of dwelling units l If garage, number of cars /,O A - Addition Alteration Other Work Fee (Description) (to be paid on filing this application) Number of dwelling units on each floor t~) ~v 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front _.{ .~. ~- t Rear ~ ~/. ~ .Depth Height ~.~ ~ Number of Stories 9. Size of lot: Front I~' Dimensions of same structure with alterations or additions: Front Depth ~c> C tt~4~ Height tO o Cet~,roc~_. Number of Stories Dimensions of entire new construction: Front IdA: Rear NJ ~' Height /~3~ Number of Stories tO A: Rear 1~-~3" Depth .Depth Rear 10. Date of Purchase 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: NJ O' 13. Will lot be re-graded k3 ~ Will excess fill be removed from premises: YES NO .A, rO~>~v,/ ¢vt&e..-into rJ.,OO O, tc~:-S' &'T- 14. Names of Owner of premises ~- C.,~;~'~ · Address 1Btz~ov--c~q~l it~.ot Phone No. ~ I Name of Architect Address Phone No Name of Contractor ~.*,~O -~5~x t~c-~ Address ~?o t!~× tot-l, 15. Is this property within 100 feet of a tidal wetland? *YES NO · IF YES, SOUTHOLD TOWN TRUSTEES 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. STATE OF NEW YORK) COUNTY OF,~f ~-~[~--S?: ~. ~w'~ ~ X-D O ~ O gc.~.(, being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ('n-.-.~q~O~gM~,~. C~3f~3~tto~A~C"'U'O6~. ~_ontracto-o-~ Agent, Corpora{e Officer, etc.) of said owner or owners, and is duly author/zed 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. Swor~t.o before n~ __ ~ ',/k~ das/of/',.~.lk~:roo~ -f 20 O ~ ~ ~/~t~ Public / QuOi~ in Suffolk Coun~ /No. 01SC4725~ _ ~ · er~ ~pires May 31, ~ FEB 3 ~I}B ~ 2- X12~EAI~ ~- DO IBLEX 4 ~. 2 XL4 ST( OL 2 )< 14 ST[ DS ~ 16" O.C. / HEADER DETAIL 1/2"= 1'0" ENVIRONMENT EAST INC. FE~ ~E[13 '1- 2 SHEETS OF 1/2' CDX PLYVVD. GLUED TOGETHER WITH PL PREMIUM ADHESIVE GRAIN ON LOWER SHEET TO BE OPPPOSITE TO UPPER SHEET. FINISHED SHU'I'rER TO BE 2' MIN. LARGER THAN WINDOW. STORM SHUTTER ENVIRONMENT EAST INC. WINOOW ~Tr: 18 2'6' X 3'0' ~., ~, LTING ENGINEERS OUTGHOGUE, NY 11ga~ E16-784-74~ ~ NN. LWAY ~ EUHI~TE C~O~ET & I [] ~x~ 2 - 2X12 HEN)E~ APPI~OVED AS NOTED 735-1802 9 AM TO 4* PM FOR THE Fg~ [.~WtNG INSPECTIONS: . ~ !OATION - TWO REQUIRED ~ ,. OURED CONCRETE 2 Pq)~JGH · FRAMING & PLUMBING 3. INSULATION 4, FINAL - CONSTRUCTION MUST SE COMPLETE FOR ALL CONSTRUCTION SRAU. MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION · ENERGY CODES. NOT RE~i~ON$1BLE FOR DESIGN OR CON~ ERRORS CASEY / MARTIN RESIDENCE PHASE II DESIGN #1 9.18.02 1/4' = 1'0' REVISED 1.3.03 REVISED 1.9.03 REVISED 1.23.03 IL=W DJ.I. OCCUPANCY USE IS UN[~4-/ WITHOUT CERTIFiC, OF OCCUPANCY P.O. B~X 1033 COX (;UTCHOGUE, NY 1193,5 516-73~749~,