HomeMy WebLinkAbout26928-z 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. 26928 Z Date NOVEMBER 15, 2000
Permission is hereby granted to:
BARBARA M DICKEYSON
334 LEEWARD D13.
JUPITER FL, 33477
for
VOID VOID VOID VOID VOID VOID V ID VOID
at premises located at 14245 SOUNDVIEW AVE SOUTHOLD
County Tax Map No. 47 889 Section 050 Block 0003 Lot No. 022 . 003
pursuant to applic tion dated SEPTEMBER 14 , 2000 and approved by the
Building Inspect r to expire on JUNE 15, 2002 .
Fee $ 458 . 20
Authorized Signature
COPY
lev. 5/8/02
I
w:ELD INSPECTION REPORT DATE COMMENTS
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)UNDATION__ (2ND)______
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r, 1P BOARD OF HEALTH . . . . . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
T-,,^ „_; TEL; 765-1802 NOTIFY: John Dempsey
CALL 734 6058
Examined... //........ �Q.�4� MAIL. T0: .C4l1 -W
Approved....!!,1.ef........ .... Permit No. ..:o ,/. p i c k up
Disapproved a/c .................................. ............. . . . . ..... . .... . ....
......................................................
.. ..................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Da t eSeptember. .14. . , 200D.
INSTRUCTIONS
a. 'this application mist be completely filled in by typewriter or in ink and submitted to the Ikrilding Inspector
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 giving a detailed description of layout of property must be drawn on the diagram which is part o
this application.
c. The work covered by this application may not be cam enced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector krill issue a Building Permit to the applicant. Suc
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 whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MAW to the Building Department for the issuance of a Building Pennit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordirk-races 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 inspect ions. �1
.Jrohn.R.—Dempsey... .
(Signature of applicant, r if a rat on
.P4.Box.5,..Cutchague.,. .NY... .1.19.3.5. . . ..
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plud)er or b(lil
......contract.vendee ...John.R...Dem�seX.. ................................... . . .. . . . . . .. ... . .. . . . . .. . . .
Nave of owner of premises ,• Barbara Dickerson contract vendor
.......................................................... ... ... . . . .... .. . . . . . . . . .. . .
(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. ....................
1. Location of land on which proposed work will be done.................................... .. . . . . .
Soundview Avenue, Southold, New York 11971
................. ............................... ....... .. . . . . . .. . . . .. . . . . . . . . . . . .
House Number Street Hamlet
County Tax Map No. 1000 Section ....5.0......... Block ....3........... Lot 2 2..3...... ....
Subdivision ...................................... Filed Map No. ............... Lot
(Nam')
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ac an t..land..................... ............. .. .. . .. . . ... . .. . ...... .
b. Intended use and occupancy ...QUQ. an j.1 Y..ON elling.............
s . ,
3. Nrture of work (check which applicable): New Building ..XX.... Addition .......... Alteration ..........
itcpair .. ... ... . . .. Removal ............. Demolition ............ Other Work ..................................
(Description)
it. Lstinut&l Cos(: . .$1.5.0,:00.0........... fee ..............................................
(to be paid on filing this application)
5. 1f (k.ellirig, nni-,weer of dwelling emits ...7........ Number of dwelling units on each floor ................
1Fgarage, rxri)er of cars ...a..................................
6. If IxrsirK ss, ccinnercial or mixed occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing stnictures, if any: Front................ hear ............... Depth .................
Ik!iglrt . .. . . . . . . . . . . . ........... Number of Stories ......................
Dimensions of sane stnnctvre with alterations or additions: Front ............... Rear ...............
Depth .. . . .. . . . . . . . . . . .... lleight .................... Number of Stories ...............
8. Dimensions of entire new construction: Dont .f19!........... Rear ..49 .......... Depth .3.q..........
Ik-iOlt .2.2!... . .. . . ....... ..... Number of Stories ....2................
9. Size of lot: Front ..19.0.'............. Rear ...13•Q............. Depth . 240 : ,_. 303 .
10. lkrte of 1'irchase under..aontr.aCt Name of Former Owner ........................................
1 1. Zone or use district in which premises are situated ....rQ.9LidQntl4l.........................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...no.......
13. will lot be regraded ...??9..,....,•,•„ used for backfill
Will excess fill be removed from premises: YES NU
14. Nacos of Owner of prerrisesBarbara Dickerson Address Jupiter, FL 56Phone 1.575-2608
applicant/contract vendee """""""""""
N`,me of * i ............ AddressPO..$Q ..J.�. Cutchoque I� No. 734 6058
'�ohri k 'D'empsey' .. ..............
wme of Ccxrtractor Inland.HomeA................. Address .Mattituck.......... ..... f1 298 9696
15. Is this property within 300 feet of a tidal wetland? * YES .......... NO .. X.....
*I F YES, SCXMYN n 1ua1 'I13fS'IIB.S PERMIT MAY HE REQUIRM.
PLOT DIAGRAM
14xate clearly and distinctly all buildings, whether existing or proposed, and indicate all set—back dimensions
f-rrm property lines. Give street and block number or description according to deed, and show street names and indicate
Mletlwr interior or corner lot.
Sf�"Il; (A. "w Y(AT,
SS
CWNIY (A' .. . . . . . . . ... . . . . . . . ....
John R. Dempsey
contract)of i
.
(Name ...... ...............being duly sworn, deposes and says that he is the applicant
rxlividiial signing,
above awed,
Ile is the .. . . . . app1..C.ant/contract vendee
(('.contractor, agent, corporate officer,.etc.).....................••"
of said owner or cxox--rs, and is (filly authorized to perform or have performed the said work and to make and file this
applicatiorn; that. all state ruts contained in this application are true to the best of his knowledge and belief; and
that t_he work will be performed in the manner set forth in the application filed therewith.
%orn to Ipfor(� rru (leis
. .. . . . .. .... . . . .. .clay of �Q,����!`:.. :20•QO...
Notary Public
MONIOU M. MASCUNANA
Notary Public,State of New York (Si of Applicant)
No. 01 MA6003807
Qualified in Suffolk County ,l`��l
Commission Expires MarCh 09,�D
DWELLING
SURVEY OF PROPERTY
SITUATED AT
AM SOUTHOLD j
D S8,
TOWN OF SOUTHOLD '
ZQ'' k o \ �� SUFFOLK COUNTY, NEW YORK
'`. F r !`� S.C. TAX No. 1000-50-03-22.3
as'o_ \ SCALE i "=40'
1'4F DECEMBER 2, 1999
C'+NT G�C \ � MAY 19, 2nO0 UPDATE SURVEY N ADDED PLOT PLAN
AREA = 43,813.61 sq. it.
O • \ `...' 1.006 cc.
SUFFOLK COUNTY E)EPARThri0hHEALTH SERVICES
N \ �, PERMIT FOR AD$ROV OF CONST RL1('fi )N FOR A
T 0 I. ELEVATIONS ARE ELEVATIONS
TO ANTHUS:ASSUMED DATUM
> q E $?y 'bp Y Ft£5ILEN�E ONLY EgSTMF DMAP Mf SHOWN
THUS:340
,�,_(0�,l) (}��e ��/� /�,,^ I _ Y. RC(fil TO (RED WP (dl TEST YIXE DATA.
�� , �'v [W ISGFa IR/. `��vv i •L O S MMMUY SEPTIC TAIKK CAPACTINS CORA 1 TO A BCDROOY NOUS( IS 1,000 WLLONS.
v, ,R� J I TNR(: 6' LONG, 4'-l' WIDE, 6'-7• DEEP
�AT6 / A MINIMUM LEACHO46 SYSTEM FOR A I TO 4 BEDROOM HOUSE IS W a4 II SIDEWALL AREA.
APPROVED I POOL; 12' DEEP, e' IN..
o
FM�MY S�M \ 3O PROPOSED EAPAI�ON P L
&&WMY ;A /xgORAiAXA'UA10F ROOMS C
/ Y H TH �\` \ C, 7r . 01 REIMPOSED LEACHING POOL i
" I
�!. `p J�p[R$S MM YEARS FROM DATE OF APPROVAL 0 PTpP06FD ,E.,K TALAR
5 THE PROPOSED SEWAGE DISPOSAL SYSTEM SMALL BE EFFECTIVELY DUG OUT, DOWN TO
A SIX (6) FOOT STRATA a ACCEPTABLE SAME) AND URAVU, FON A MAI4I i1E Do F(LI
�Q VACANT \- I .... .. GREATER IMAM THE LEACK I PONT.
�y,RYS/. 6 AREA OF EXCAVATION TO BE BACN(Il1ED WITH ACCCPTABLF SAND R GRAVEL.
7 THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
DBSERVATIONS AND/OR DATA OBTAWD (POM OTHERS.
i \ ORM 1Y
TEST HOLE DATA
IfFSF HOLE DoC 8I Mc A"] GEOSCIENCf ON MAI 2?. 10(10)
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V" ADS FOR TITLE SUFN LSTASUSHED
\. \\\ / ,(a RN MS AS Ai s AND APPRMPO ANL AUDI
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SUCH M EY TIIF NDA IDPA $TATE WN
F A540CIATIDN
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N.'S Lc No 49668
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TO THC, ZFSURYFr F A Nd,ADON f
CERTIFIED TY: \ Y' / f�T�7�Or %>a NEW.[WI SiA'[
CHICAGO TITLE INSURANCE COMPANY �, \. oseph A. X19®9110
cwLs IF rHc wFrvLr aMP NOD BEARING.
b r \\ LMI I LRM10P'O W1M`FSEM pi Land
A_ _—v®yor
JOHN R. DEMP5EY 5S ,7 % io WE iAi rsR r Yr �aMsnRED iSAitlflRlVl VVWWr
' �- - CCYTPI[AfNkb INDICATED HRSpI SWILL RUR ----
A MY 10 THE PERSON FOR WHOM THE SURVEY —
OA. 15 Coldl . 0M WS 6PNA41 low
-
V Is LJYP.Wa. I NYKMIh AC.EMCY AND urvRla LOV4JI
LENDING RIBPTUTRRL LISTED HEREON. AND
DJ Lam' TUTON CERTIIFIASTIONS ACRE UrIDF TwNFFRAINE. PHONE (631)727-2090 } 27-1727 1
b• fD4 (637 7
THE ERNS EASE OF ROF EC WAYS OFFICES LOCATED AT 4Y(MIG ADDRESS I
AND/OP SHOWN
OF RECORD, N
OANOKE
EMA
I
DWELLING ANY, NOT SHOWN ARE NOT GUARANTEED F E�CAO, Ne. Y11x 11901 Mr.eHre,O.F NnNlork 4I 11IVf11-09L' 1
4lI J�"
DO NOT PROCEED WITH
FRAMING UNTIL SURVEY
F OF FOUNDATION LOCATION
APPROVED AS NOTED HAS BEEN APPROVED.
i" .�,�'• { DATE: / -d B.P. k a6 9
FEE: BY:,
1 (- - - I _ - NOTIFY BUILDING DEPARTMENT qT OCCUPANCY OR
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING IUSE IS UNLAWFUL
NSPECTIONS:
I -- - 1 FOUNDATION - TWO REQUIRED WITHOUT CERTIFICATE
! FOR POURED CONCRETE
2. ROUGH „ FRAMIY3 & PLUMBING
3 F INSULATION OCCUPANCY
4. FINAL - CONSTRUCTION
BE COMPLETE FOR C.OMUST
.
_ ALL CONSTRUCTION SHALL MEET IRT
THE REQUIREMENTS OF THE N.V. ALARM REQUIRED
SYSTEMS STATE CONSTRUCTION & ENERGY S
- -� CODES. NOT RESPONSIBLE FOR ALARM LAZY
-`^ ' - _.,.._._..._.,____ _ _ _ _ _ DESIGN OR CONSTRUCTION ERRORS
PROVIDE ANTI-SCALD AND/OR
_r T
PROVIDE OPENINGS FOR THERMAL SHOCK PREVENTING
ER DEVICES A
GE S
NC i0 P
C � Y
' ESCAPE AS ARL 902.6 K
REQUIRED BY PARE 714 OF N.Y. STATE BUILDING CODE.
N.Y. STATE BUILDING CODE.
PLUG
_ MNG
_T_ &LWAi FI LINES NEED
MBING WASTE
PROVIDE smoxE D
TESTING BEFORE COVERING
-- ALARM DEVICESCTING
M AS TO PART
7211
N.Y.S BUILDING CODE. IforoPPer H ester stn Is used
.,_ .'� t hh i 1 c t, system:ei dist shall be
n w a
Of tYPes IC or=y
UNDERWRITERS
CERTIFICATE UNDERWRITERS CERTIFICATE
- - „ REQUIRED REQUIRED
PROVIDE % HR. FIRE PLUMBER CERTIFICATION
FATED S 7.3 (f) (1) OF CERTLFICATE OF OCCUPANCY
PART. 717.3 (f) (1) OF
N. . STATE BUILDING CODE.
Y SOLDER USED/N WATER
SUPPLY SYSTEM CANNOT
EXCEED2110 OF 1%LEAD.
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