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HomeMy WebLinkAbout23115-zFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24100 Date DECEMBER 28, 1995 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Propert~ 580 BROADWATERS ROAD CUTCHOGUE NY House No. Street Hamlet County Tax Map No. 1000 Section 104 Block 10 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 31, 1995 pursuant to which Building Permit No. 23115-Z dated NO~EMBER 17, 1995 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 AN ADDITION AND ALTERATION TO AN EXISTINO ACCESSORY SHED TO CHANGE IT INTO ANACCESSORY GARAGE AS APPLIED FOR. The certificate is issued to LOUIS & SONIA SULICH (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/a N/A Rev. 1/81 / ~uilding Inspector FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 23115 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ~'~. .:.....:.,~~......~ ............................ '~, ~, x~, ./.~ ¥/ ,o~/~~~:....~' ~~~: ....... ~~~ ........ CounlyTax Map No. 1000 Section ....... .~....~....../~.... Block ............ .~..~ ....... Lot No ........ ~ .............. pursuant to application dated ..../ff...47./~../:~..' ................................... Building Inspector. Fee $. ~....~.~./...,~.. 1 9..?.~, and approved by the Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT .'i ' .~ TOWN HALL APPLICATION FOH C~HTIFRCA~ OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to t~e~Uilding inspector with the following: 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '!pre-existi~g" 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 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. ~. 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .. ~1'~/~,,~ / .~..~, New Construction ........· . . Old Or Pre-existing Building ............... · · of Property ..... Location ' Rouse Ne. Street Ramlet Onwer or Owners' of Property... ~.O..~..%~...~,.. ~....~.~. B%~..$O ~C..~. · ....................... County Tax Map No 1000, Section...[Q~ ....... Block...%.~ ........... Lot....~. ................. Subdivision~Q .~-~...~.%,o0. ~. ?.~O?.~R%[~. ~, .~.C. Filed Map..%.~..~. ...... Lot... ~..~-~- ............... Permit No....~.~..~.~..~..~..Date Of Permit..~/~.~/~- .~. .... Applicant..¥.0.~. ).~..~.~..~.~.~].~...d~. Approval Underwriters Approval ......................... Health Dept · .- Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................. ..~.....~j~,~,...2 ~....~.~.. lO0 P ICANT Town Hall, 53095 Main Road P. O, Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 21, 1995 Mr. Louis F. Sulich P.O. Box 1091 Cutchogue, NY 11935 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 23115-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FIELD INSpeCTION REPORT DATE COMMENTS --- FOUNDATION (1ST) Il I~ FOUNDATION (2ND) ~= ~ tml ............................................ INSULATION PER N.Y. II Il STATE ENERG7 FINAL ADDITIONAL COI~ENTS: i l' 4O0 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION :)ND [ ] INS/~JI~ATION FRAMING [ ~/1~1 NAL REMARKs: / DATE C I-4 738-00527/0000 I-0 PERMIT Under the Environmental Conse~'vallon Law (ECL) Oct. 13, 1992 Oct. 31, 1994 m----] Article ts, Tille 5: Protection of Water m~-~ Article ts, Title 15: Water Supply m----m Article 15, Title 15: Water Transport r----] Article 15, Title 15: Long island Wells ~-~ Article t7, Titles 7. 8: ~ SPDES J'--"'~ Article t9: ~ Air Pollution Control J------J Article 23, Title 2h Mined Land Reclamation , , ~ Adicle 24: ~-I Freshwater Wetlands Article 25: · Tidal Wetlands J J Article 27, Title 7; 6NYCRR 360: Solid Waste Management Article tS, Title 27: ~ Wlid, Scenic and Recreational I Rivers j------J 6NYCRR 608: Water Quality Cedification Artide 27, Title g; 6NYCRR 373: · Hazardous Waste Management Ailicle 34: Coastal Erosion Management Afllcle 36: Floodplain Management Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control Other: PERMIT iSSUED TO J TELEPHONE Louis F. Sulich, P.E. J ADDRESS Or PERMJTTEE 14,-05 156 St.~ Beechhurst~ NY 11357 NAM~ AND ADDRESS OF PROJECT/FACILITY Sulich Property N.S Broadwaters Rd.~ Cu'tchogue LOCATION OF PROIECTIFACILtTY SCTM,#1000-I04-10-3 CODNTY J TOWNICJJy~Z~4~E W^tERCOURSEIWErLANONO J NYTMCOOROINATES Suffolk Southold Broa~ate~vm E' __ N.4 DESCRIPTION OF AUIIIORIZEO ACTIVITY Place approximately 80 cubic yards of upland fill to raise the grade df the oroner~v around an existing house. Raise house by adding concrete block to existing foundation. Construct 2 new additions to a[tach to the south side of house and a new d~ck on north side. All work shall be in accordance with NYSDEC approved plans attached. By acceptance of this permit, the permittee agrees that the permit }s contingent upon strict compliance with the ECL, all applicable regulations, the General CondiUons specified (See Reverse Side) and any Special Conditions included as part of this.permit. V I0/13/92 Page 1 of 5 'J'he roi. lowing conditions apply to afl permits: /%. If any of ~he permJ, t conditions ate unclear,Urn perm~ttee shall con- tact the DJ. vision o~ Regulatory Affairs at the address and tel. epho~e noted below. B. h copy o[ ~ll~$ permit with supplementary cosdJtioss and approved plans shal~ be available at the project sJte whenever authorized wot'k ~ In progress. C. The permit sign esclo~ed with the permit or a copy of letter of approval shall be protected from the weather and posted in a coe- . spicuous .tocatton ah the wink site nnttl completion of authorized work. O. ~ l~a~E 4~ h0~t~ ~9~ E0. coi,meflceme?~ o~ ~he. ptoje~t, ,c6~%~yln9 .klia~ h~...i~. ~ully a~at~ of and unde~tand9 a~l. p~ovi~ions asd cO~dttton~ ~ ~ttlM p~ml(~ WtU~]n oae week of compleklon o[ the permitted work, the bok~om porklon of thak form shall also be com- pleted aad returned. E. For projeckm lnvolvin9 ackivittes ko be a~comptlsbed over a period more tban One year, the permltkee ~hall notify him RegioSa] ~dmln~iskrator in wrikin9 ak least 48 hours prior to klm commencement of resumpkion of work each year. F. If projeck design modificakio s Lake place after permiL lssua ce, the permlttee shall submi~ the approprta%~ plan changes for approval by the Regional Permit Admialstrator prio~ to nndertaki~{g any such modi- fications. The permittee ts advised that substastla], mod~f~catto may require submlsslos of a new application for permit. G. All necessary precautioss shall be taken to preclude contamination any w~%lands or waterway by suspeuded solids, sedJ,mnt, [nels, solvents, lubrlcasts, epoxy coatings, paints, concrete, leachate any other environmentally deleterious materials'associated wi%h the project work. Asy fatlnr~ to comply precisely with afl of the terms and cosditlons of tbls perm[t, unless authorized in writing, shat1 be treated as a violation of ~he Environmental Con~ervation J, aw. I. The permtttee is advised to obtais asy permits-or approva}a that may be requ]red from the U.S. Department of Army Corps District, 26 Federal Plaza, New Yo~k, NY 10278, (httentlon~ Functions [3~anch), prl6r to commencement o~ work anthorized herein. J. The grantiilg of this permit does ,or relieve the permiLtee of the responsibility of obtatnlng a grast, easeme?t, o~ other necessary approval from the Division of band Utilization, Office o~ General Servlceg~ Tower ~utldin9, Empire State Plaza, Albany, ~Y 12242, which may be requited for any encroachment upon State-owned lands llnderwater. Regional Permit Admlnlstrator N¥S Dept, o~ Bnvi~onment~] Cosservation Bldg. 40, ~UNY-Room Stony Bt'ook, fly (516) g That it [uture o~erations by the State of New York require arq al. /era/ion in /he position of the ~tructure or work hPrein authorized, or project ot SPECIAL CONDITIONS **Approved Planl One sheet prepared by Louis F. Sullch, P.E. revised 5/13/92 and sthmped "NYSDEC A~proved As Per Terms and ~ Conditions of Permit #1-4738-00527/00p01-0 10/9/92." · 1. A sediment barrier consis~ing of row of hay bales staked end to end shall be'in ~lace at the s~award toe of the area to be filled before any fill ]s placed. Th~se hay bales shall be maintained in place until the fill area is stabilized with vegetation. 2. During construction, no wet or fresh concrete or leachate shall be allowed to escape or be discharged, nor shall washings from transit mix trucks, mixers, or o~her devices be allowed to enter tidal wetlands. 3. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and ~removed to an approved upland area for disposal. No debris is permitted in tidal wetlands.. 4. The s~orage of construction equipment and materials shall be confined to within the project work site and/or upland areas greater than 50 linear feet distant from the tidal wetland boundary. I-4738-00527 / 00001-0 of 5 TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. Jolm L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTF L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 March 6, 1992 Louis Sulich 14-05 156 Street Beechhurst, NY 11357 RE: SCTM ~1000-104-10-3 Dear Mr. Sulich: The following action was taken by the Southold Town Board of Trustees on February 27, 1992: RESOLVED that the Southold Town Board of Trustees approves the request for a waiver to construct an addition to existing dwelling as per survey submitted. Please note that permits from other agencies may be necessary, as the Trustees approval does not constitute approvals from other agencies. If you have any questions, please do not hesitate to contact this office. ~o~yn Mtruly yours, President, Board of Trustees JMB:jmt cc: Bldg. Dept. CAC Newt York State Department of Environmental Conservation Building 40--SUNY, Slony Brook, New York 11790-2356 (516) 751- 1389 Thomas C. Jorllng Commissioner Louis F. Sulich, P.E. · 14-05 156 St. Beechhurst, NY 11357 Oct. 13, ~992 Permit #1-4738-00527/00001-0 Dear Mr.Sulich: In conformance with the requirements of the State Uniform Procedures Act (Article 70,ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If yon are unable to comply with any conditions, please contact us'at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, George Hammsrth Sr. Environmentol Anolyst Gtl/rw enclosure Appendix F Slate Envlro.mental Quality Review NEGATIVE DECLARATION Notice of Determination of Non*Slgnlflcance SEQR Project Number ]-4738-00527/00.00 I-0 Date Oc~. 13, I992 This notice la Iseued pursuant to Part 617 of the Implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Conservation Law. The N.Y.S. Dept. of Environmental Conservatio~t , as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: Sulich Ilouse Improvements SEQR Status: Type I Unlleted ~]- Unlisted Action lcoated in Peconic Bay CEA Conditioned Negative Declaration: [] Yes [[]No DeeoHpllon ol A~R~I: Placement of approximately 80 cubic yards of fill in the area around an exisi~ng single family dwelling to raise grade by approximately 1.5 feet Raise house by approximately 2 fee~ in elevation by addiug several courses of concrete block to the existing foundation. Construct two additions and a deck to attach to the existing structure. Lo~atlon: (Include street address a~d Ihe name of the municipality/county. A location map of appropriate scale la also recommended.) North side of Broadwaters Road Cutchogue Broadwaters Cove; Town of Soutbold, Suffolk County SCTM #~000-~04-~0-3 c~ ~J ~J © © > © ~o For Article.__ 5. All fill SPECIAL CONDITIONS 25 (. Tidal Wetlands shall consist of "clean" gravel and soil (not asphalt, slag, flyash, broken concrete or demolition debris). Supplementary Special Conditions (A) thru (J) attached. 1-4738-00527/00001-0 FACILITY ID NUMB[R lI'rOGRAM NUMB[R 4 5 · Page __ of __ PROPOSAL Daniel L. Fischer Carpenter Home Improvement C~ontractor 38785 Main Road Orient, NY 11957 (516) 323*3868 Surf. County Lic.# 13943HI Addres~ Broad. waters Road Nassau Point, NY 11935 Date N~nb~r 17: lqq~ We propose Convert shed 5o 9arage hyL ~b~p~ ~H~t]nn ~% ~ro~= ~ppro:dmnt'::ly 15 ~' 3 and 4 × 3. Foundation perimeter footing 3s deep including under apron. Apron for 8' wide door. Slab for new extension at same level as existing with expansion joint and reinforcing wire. CCA sill, 2 x ~ studs and 2 x 6 rafters, ½" CDX ~11 and roof sheathing. Flush rakes of 1 x 6 pine - primed. Siding 24" resa~ handsplit heavies at 10" exposure. Cheek of extension stepflashed to existinG roof on north side. Roofing to match existing. Frame and jamb for 8'x 7' overhead door (installed by others). Ail debris removed. O~er to obtain permit. $ 3317.00 We hereby propose fo furnish labor and materials -- complete in accordance wlth the above spedficatlon~, far the sum of: dollars ($ ) with payment to be mode os followst All material }s guaranteed to be as, specified. All work fo be completed Se o workmanlike manner according to standard practices. Any alteration or deviation from above spec;fical;ons involving extra costs, will be executed on~ynu~p~..~upon rltten orders, and will become on e~lra charge over and above by u, if not accepted within 30 day,. Authorized Signature ~/~ ~ ~' Acceptance of Proposal The above pNces, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. .Signature Accepted: Date 1 0 0 0 © r~ © © r~ ' ', I ,I I',,~ TOWN OF SOUTHO LD i;J( 0b'~T 8'1 ~9~ I~,,~ BUILDING DEPARTMENT ;' ~, ............ il'', TOWN HALL ~ BLOG DE '~, "i SOUTHOLD, N Y 11971 Examined . , 19 '' ' Approved ..' ...... 19~P~rmit No. .'¢' . D sam>roved' ale i// [ "'* ' / ':r' 'APPLICATION FOR BUILDING'PERMIT ' 3 sETs OF PLAX$ c,:c ..i.. . SEPTIC FORH CALL ............ MAIL TO: Name of owner of premises ... ~"~.0. ~.~...~'., A~. $,l~-~j ( on t e tax roll or latest deed) If applicant is a corporation, signatqre of duly autboriied officer. ' Stat~ existing use and occupanc a. Existing use and occupa'ncy b. Intended use 'and occupancy : (Name and title of corporate officer) Plumber's License No ............. . ........ Electrician's License No .... . ................ Other Trade's License No ~ Location of land on which proposed work will be done ............... ...... ........... House Number Street Hamlet ounty ' 4 [O. ~ t.O ' C Tax Map No. 000 Sect:mn IO · ~'. ~. Block Lot Subdivision N~.~h~ ~..C'-.~ .T~[~5 [~¢Filed Map No.. , ~,, ' (Name) . I' .[.~ ...... Lot ........ of premises and intended use and occupancy of proposed construction: . .' · ~. :LO0 ~ 'r ~'{~ ~Lto.~ ~.:'.,Daffl~9 Y~A.~OM ............ State whether applicant is owner, ilessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder. t , . .. .... ~, ,.. D,ate ............... , 19... INSTRUCTIONS a. Thi~ application must be completely filled in by t3,pewriter or in ink and subinitted to the Building Inspector, with 3 ets of plans, accurate plot plan to s~ate. Fee accord!rig to schedule. b. Plot plan showing location 9f lot and of buildings on premises, relationship to adjoining premises or public sti'eets or areas, and giving a detailed descriiptioh of layout of property mu~t be drawn on the diagram which is part of this appli- cation· , c. The work covered by this application may not be commenced before issuance of Bu/lding Permit. d. Upon approval of this apphcation, the Bmldmg Inspector '~fll issued a Building Permit to tlie applicant. Sucli 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 liave been granted by tlie Buildlng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zoue Ordinance of the Town of South01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for he construction o.f buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply wiih all applicable laws, ordinances, building code. housing code, and regulations, and to admit authorized inspectors on preraises and in building for nedessary inspections~ -- . . (Signature t~t~phc~nt, or name,']JY~ corporation) · (Mailhig address of applicaflt) -3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ....... i.. Repair .............. Removal .............. Demolition ......... Other Work ............... 4. Estimated Cost. [ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ---: .... Number of dwelling units on each floor · If garage, num bet of ears ..... ~. ...... ' ................ If business, commercial or roi.xed occupancy, specify nature and extent of,each type of use ..................... 7. Dimensions of existing structures, if any; Front, 4[.' ........... Rear .. It: ......... l~pth . ~,~'.-.~.~. i ..... } · teight .. I.I, ........... Number of Stories .... 1... ' D mensions of shine structure with alterations or additions: Front . :[..t~.' ............ Rear ... ~1. ...... Depth ... [ .o~.,_..~ ...... Height [~'. i ............. ' ........ ;.. Number of Stories...~. ...... ' 8. Dimensions of entire new construction: Front ... [ .......... Rear · .ti ...... epth . ),.q... ,% ........ Height . . .[[ ........... Number of Stories 9. Sizeoflot: Front ..... (1.~..¥ ......... Rear ."t ...... · ~.~ ........... Depth ..~1.~: . . 10. Date of Purchase ~f~..'~, '. I .q.~.~:'[ ............ Name of Former Owner . O.O P[I'.~I. Z.. ,.,q. CP[t2 L'i'~ 11. Zone or use district in which premises are situated · It:%' ~l~.,~lI~.l~tq.Tl~,~ -~,r.~,., ~, ,~,,~ ~,,,,, . 12. D°es pr°p°sed construction wolate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ... ~"1 ~1.; .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~.~-.~..~..kl ~./..(,< .~. .... Address~.{tO. l~0~,/l.~'~gJ .~. Phone No..~I~.4 :~.'Z~...'?~. ' Name of Architect ...... ;,. · .' ................. Address ..... ,: ............. Phone No ........... Name of Contractor ~),~t~. J~,.~).~,.t;~l~.., . Address~.~}'/~e~ .~[hJ ~9,,OJ~trehone No ;~;~a~.-nj~.'./~.' ' ' ' 15.' I.s this property within 300 feet of a '~id'al wetla'~d? '~Ye ''v" '" ..... '"'-' . *If yes, Southold Town Trustees Permit may be requirS;~l[ ..... No ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whethgr existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot, ;TATE OF NEW YOI~J~,c.c.,~' ;OUNTY OF .....~v,~.~0,~ .... S.S : ....Lt. 0.~t.~...~'..,. '..~. '.. L,,\ C-,~L- being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. is the .......................................................................... . .............. (Contractor, agent, cor'porate officer,etc.) said owner or owners, 9nd .is ~d,uly, a~thorized to p6rform. 6~ ha~ perfbrmed? t~e said work and to m~e and file this ~plication; that all ~taiem'ents contained ~ this'application are irue to the best of his knowledge and belief; and that the ork will be perfomed in the ~er set forth in the application filed therewith. ' ~om to before me this ,ta~ Pubhc .... z<~~~. :'~ County So. 4725089..Suflo~R. . , } . , , , , ' (Signature of applicant) .Lo½ I~t~ 157 !