HomeMy WebLinkAbout49430-Z ` SUFFO(K Town of Southold
7/15/2023
P.O.Box 1179
o • .i 53095 Main Rd
y?j01 �,ao� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44298 Date: 7/15/2023
THIS CERTIFIES that the building PORCH
Location of Property: 110 Sleepy Hollow Ln, Southold
SCTM#: 473889 Sec/Block/Lot: 78.-1-10.6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/15/2014 pursuant to which Building Permit No. 49430 dated 6/29/2023
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:
covered front porch addition to existing single family dwelling as applied for.
The certificate is issued to Neville Robert &Elizabeth Rev Trt
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED `
'Pik/
A o 'ze S ature
TOWN OF SOUTHOLD
�gUFFQI�
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
• o fi SOUTHOLD, NY
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#: 49430 Date: 6/29/2023
Permission is hereby granted to:
Neville Robert F Rev Trt
110 Sleepy Hollow Ln
PO BOX 995
Southold, NY 11971
To:
Construct a porch replacement as applied for Replaces BP 42111
At premises located at:
110 Sleepy Hollow Ln, Southold
SCTM # 473889
Sec/Block/Lot# 78.-1-10.6
Pursuant to application dated 8/15/2014 and approved by the Building Inspector.
To expire on 12/27/2024.
Fees:
PERMIT RENEWAL $125.00
Total: $125.00
Building Inspector
o�guFFot,r�o TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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#: 42111 Date: 11/2/2017
Permission is hereby granted to:
Neville Robert F Rev Trt
110 Sleepy Hollow Ln
PO BOX 995
Southold, NY 11971
To: Construct a porch replacement as applied for.
Replaces BP#39130.
At premises located at:
110 Sleepy Hollow Ln., Southold
SCTM # 473889
Sec/Block/Lot# 78.-1-10.6
Pursuant to application dated 11/2/2017 and approved by the Building Inspector.
To expire on 5/4/2019.
Fees:
PERMIT RENEWAL $100.00
- $100.00
i
Building Inspector
TOWN OF SOUTHOLD
�SUFFot,r�o
o BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
�Ol 'w �ao�jss
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#: 39130 Date: 8/21/2014
Permission is hereby granted to:
Neville Robert F & Elizabeth A Revoc Trt
110 Sleepy Hollow Ln
PO BOX 995
Southold, NY 11971
To: construct a porch replacement as applied for.
At premises located at:
110 Sleepy Hollow Ln, Southold
SCTM # 473889
Sec/Block/Lot# 78.-1-10.6
Pursuant to application dated 8/18/2014 and approved by the Building Inspector.
To expire on 2/19/2016.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00
CO -ALTERATION TO DWELLING $50.00
Total: $250.00
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
D ted 8/18/2014
New Construction: Old or Pre-existing Building: )( (check one)
Location of Property. 110 Sleepy Hollow Lane, Southodl, New York 11971
House No. Street Hamlet
Owner or Owners ofProperty� Robert F. 8 Elizabeth A. Neville
Suffolk County Tax Map No 1000, Section 78.1 Block 1— Lot 10.6
Subdivision Sleepy Hollow Filed Map. 6351 Lot: 4
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: X (check one)
Fee Submitted: $ 50.00
on C2
V licant Signature
souryo
# # TOWN OF SOUTHOLD BUILDING DEPT.
cauxne 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] NSULATION/ ULKING
[ ] FRAMING /STRAPPING ] FINAL f�
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ PRE C/O [ ] RENTAL
REMARKS.
r WA v
�lo
cv ti
DATE INSPECTOR
�� ho�aOE SOUIyO�
TOWN OF SOUTHOLD BUILDING DEPT.
coum, 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULATION/CAULKING
[ ] FRAMING/STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
f
DATE INSPECTOR
FIELD IlxSPEQN"REPORT DAT# COMMENTS
AR
FQUN D,ATIOX(1ST)
FOUNDATION(2ND)
s . . m Ip
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ROUGH FRANILNGdi
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PLUMBING
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INSULATION PEA N.Y. �H
STATE ENERGY CODE
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FINAL ,
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8/15/14 Page 1 of 2
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 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502/ Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined y ,201� Stonn-Water Assessment Form
L Contact:
Approved 6�4,20 lT Mail to:
Disapproved a/c
/ Phone:
Expiration �� ,20 `"� n �j
�}n
U U Building Inspector
AUG 15 2014 LICATION FOR BUILDING PERMIT
g
BLDG.DEPT,
Date August 15, 32014
TOWN OF SOUTHOLD 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.
i nature of applicant or name,if a corporation)
PO Rnx 995, Snuthnid. NY 11971
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Owner
Name of owner of premises Robert F. & E i i zabeth A. Nev i i i e
(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:
IIS--�e{�THo1 Jow Lane, Sn ,thoId, NY 11971
House Number Street Hamlet
County Tax Map No. 1000 Section 7 R__ Block 1 — Lot 10.6
Subdivision S i e epTKo I Low Filed Map No. 6 3 51 Lot 4
8/15/14 page 2 of 2
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Pr i vate One Eami iTDwe i i i ng
b. Intended use and occupancy Same
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other WorkPor replacement
. (Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units 1 Number of dwelling units on each floor
If garage, number of cars 2
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. .
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stores` ,
Dimensions of same structure with alterations or additions: Front Rea_r
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front 7 it I Rear z R 3 Depth_i n n wt.-qt R7 east
10. Date of Purchase Arm; 1 9 —jag-9--Name of Former Owner Robe r t & Ca ro i Bohn
11. Zone or use district in which premises are situated nAn
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X
13. Will lot be re-graded? YES NO X Will excess fill be removed from premises? YES NO
Robert .F.& Elizabeth PO Box 995
14. Names of Owner of premises Nevi i ie Address Southoid,NY 11971 phone No. 631 765-2054
Name of Architect Mark Sctwart7 Address t9xogue.NY 11935Phone No 631 734.=4185
Name of Contractor Wm Toth Const 8 Mgmt Address 425 Jacobs Lane phone No. 631 765-9508
Southold, NY 11971 51.6 807.-8118
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X
* 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 X
* IF YES, D.E.C. 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.
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 OF Suffolk)
Elizabeth A Nbvt l le being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the XMr
(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 therTNNAA M. RUDDER
Notary Public,State of New York
Sworn to before me t No.01 RU6020932
S day of 20 J c{ Oualified in Suffolk County
Commission Exp'es March 88 2015
Notary Public G Signature of Applicant
ussell ,��°sU�� ���c0>>��`�C\��"A\�C'JEJE�
Scott A. R �vJCA\1 A\(G�JE�JUE1�`7C'
SUPERVISOR z �d
SOUTHOLDTOWN HALL-P.O.Box 1179 O Town ofSouthold
53095 Main Road-SOUTHOLD,NEW YORK 11971
AGEMENT-WORK SHEET
CHAPTER 236 - SrI'Q�1M'�ATER MAN
( TO BE COMPLETED BY THE APPLICANT)
- --- - --- -_ - - - - - - - - ----- - __ ._.. -- _ ._ Y___C�7E:
` DQFl S PIIS Ply®JECI' Irtqil
(hoc ALL-uNr APPL`n y
Yes No
) Q
Q A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface. I
Lj
B. Excavation or f illing involving more than 200 cubic yards of material
within any parcel or any contiguous area.
D C. Site preparation on slopes which exceed 10 feet vertical rise to .
10.0 feet of horizontal distance. l
x D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
®❑
erosion hazard area.
E. Site preparation within the .one-hundred year floodplain as depicted
on FIRM Map of any watercourse.
ious surfaces of 1,000 square
❑ F. Installation of new -or resurfaced impery
feet or more, unless prior approval of a Stormwater Management ,
Control Plan was received by the Town and the proposal includes
s
in-kind replacernent of impervious surfaces.
If you answered NO to all of the questions above, STOP'. Complete the Applicant section below with your Name,
y p to our project.
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does nota ply y P ]
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building"Department with your Building Permit Application.
_ -- -
Date
_ ------•---------------._---
&C-T.M. #: 100
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) District
78.1 1_ a0. i 8/18/2014
A1AME bent F. 8 Elizabeth A. Neville Section Block Lot
lSq n.rd
*** 17011 BUILDING DEPj;I'.T11Ei�1`f USE O;�L
Contact I formatiort 631 765-2'To05�4�Num��
Reviewed By:
- - — — — — — — — — — — — — — — — — Date
Property Address/ Location of Construction Work: — ��Approved for processing Building Permit-
Stormwater Management Control Plan Not Required.
110 Slee Hollow Lane — — _ - - — — — — — —
hold NY 11971 Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
FORM SMCP-TOS MAY 2014
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NOTIFY BUILDING DEPAR F I EV _
765-1802 8 AM TO 4 PPF FOR Tt,E - _ - - ---
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