HomeMy WebLinkAbout27736-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28004 Date: 10/05/01
THIS CERTIFIES that the building ADDITION
Location of Property: 4725 NEW SUFFOLK AVE MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 115 Block 4 Lot 8.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 26, 2001 pursuant to which
Building Permit No. 27736-Z dated SEPTEMBER 27, 2001
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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to THOMAS D & SHARON W GOELLER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
s
th rized Signature
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. 27736 Z Date SEPTEMBER 27, 2001
Permission is hereby granted to:
THOMAS D GOELLER
4725 NEW SUFFOLK AVE
MATTITUCK,NY 11952
for
CONSTRUCTION OF AN " AS BUILT " DECK ADDITION AS APPLIED FOR
at premises located at 4725 NEW SUFFOLK AVE MATTITUCK
County Tax Map No. 473889 Section 115 Block 0004 Lot No. 008 . 004
pursuant to application dated SEPTEMBER 26, 2001 and approved by the
Building Inspector.
Fee $ 300 . 00
;Y7
Authot&ed Siggature
COPY
Rev. 2/19/98
.V1 l
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR.CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
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.
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 of Occupancy on Pre-existing Buildinr: - $100.00
3. Copy of Certificate of Occupancy - , .25A
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15..00, Commercial $15.00
�S 00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. A.16G& . Old Or Pre-existing Building. . . .. . . . . . . . . . . . . .
Location of Property. . . .�t. .7. . . /.�!I �:! . :S`.'�fo�l�, , ,/f-✓,�;j , �7;�;T, Ir!c�,C; /�
House No. Street Hamlet •
Onwer or Owners of Property.. A: . '. . . .�t'.od`G�.�.:4:
County Tax Map No 1000, Section. . . .,.//4 Block. . . . . . f . . . . . . .Lot. . . . . :. . . . . . . . . . . . .
Subdivision. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . .d. � .p DOf
.�. . . . . . ate Permit. . v: ././A I. . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . .. . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Corticate. . . . . . . . . . .
Fee Submi ted: . . . . . . . . . . . . . . . . . . . . . .
$aV60
C. `p Q� � � . . . . . . . . . . . . . . . . . . . . . . . . . . .
APPLICANT
r � 765-1802
BUILDING DEPT.
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TOWN OF SOUTHOLD BUILDING PERMIT APPL1CArION CRiECKU
BUIILDING DEPART Do you have or need the following,before apply-
TOWN HALL Board of Health
SOUTHOLD,NY 11971 seta ofBuDdiag P1$a�!
TEL: 765-1802Survey �
PERNIIT NO. - - 73 �v� �
Septio Faun
. Trustees
20 0 Contact
Appro P20 Mauto:
Disapproved a/c
Phone: 224V
• ' '�� Buil p •
i
j APPLICATION FOR BUILDING PERNIIT,
Date 20a 1
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with
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 o
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 pc
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 0=43n.
is issued by the Building Inspector,
APPLICATION IS HEREBY 1VlADE 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 heron described.The
applicant agrees to comply with all applicable laws,ordinances,building code,hon ' , to admit
authorized inspectors-on piemises and in building for necessary'inspections.
(Signataro of applicant or name,if a corporation)
2�' 7� �.q•,.r • fl vq-.D �°�!�•.� g'a'd
(Maims address of applicant)
State whether applicant is owner,lessee, agent, architect, engineer,general contractor,electrician,plumber or builder
/1.yGir•���
Name of owner of premises - T/1�.•.R_t z7_ o . s-�����,,,� o,,s"GG,of
(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:
g7Z.5- x /%7 4—TTyTie—/E /�'
House Number Street Hamlet
CMJFIAO A
County Tax Map No. 1000 Section //S Block '�r ow"!o .o" q#�1aN
Subdivision Filed Map No. a"°a
(Name) .int thr"ryr t.'as Wimewu oo
. ' es and intended use and occupancy dproposed aeon:
Mate existmgnse and ooarpancyo�prctms .
a. Existing use and occupancy /l, s�.o,�-�•�. p ,
b. .Intended use and occupancy
Alteration
Nature of work(check which applicable):New Building Addition
Repair_ Removal Demolition Other Work
(Description)
Elated Cost Fee
. (to be paid on filing this application)
of dwelling units / Number of dwelling units on each floor
If dwelling,number
if garage, number of cars 2
If business, commercial,or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures,if
Front •3 o Rear Y< Depth •`rte
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories.
Dimensions of entire new construction:Front Rear " Depth
Height Number of Stories
Size of lot:Front /7SS Rear . Depth
0.Date of Purchase- Name of Fer ��YL
1.Zone or use district in which premises are situated
2.Does proposed construction violate any zoning law, ordinance or regulation: �U
3. Will lot be re-gradedW'lli excess fill be removed from premises: YES NO
4.Names of Owner ofpremises Si�.f�-�•• Address �i Phone No.21e''/ "a
Name of Architect Address Phone No
Name of Contractor Address Phone No.
`5. Is this.property within 100 feet of a tidal wetland7 *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
6. Provide survey,to scale,with accurate foundation plan and distances to property lines.
7. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
TATE OF NEW YORK)
SS:
:OUNTY OF_
/��6,y,t�- CJ Qil�,F,✓ �.,� being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
5)He is the '
(Contract#,AgentLyCorporate Officer,etc.)
f said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;
,at all statements contained in this application are true to the best of his knowledge and belied and that the work will be
erfonned in the mazmer set forth in the application-filed therewith.
wom to before me this
day of 20_L
Notary Public Signature of Applicant
NOWY NoANRVA
01CAG x7446
OoawalaioEspfrinia JaM+M1► �,. .
-__ROBERT O'BRIEN P.E. CONSULTING ENGINEERING SERVICES
2074 MAIN ROAD, P.O. BOX 456, LAUREL, NY 1 1948 631-298-5252
October 5, 2001
� a
Southold Building Department
53095 Main Road OCT _ 5
Southold, New York 11971
mot
Permit No. 277362
As-built Deck Drawing
Thomas Goeller Residence
4725 New Suffolk Avenue
Mattituck, New York 11952
Gentlemen:
This is to certify that the deck at the above-captioned house has been reinforced
to insure its structural stability and prevent further settlement. Remedial work included
the following:
(1) Installation of new double 2" x 10" center girders with additional through-bolted 4"
x 4" post supports, supported by pre-cast concrete pad footings on undisturbed
soil.
(2) Bolting of the other existing nailed 4" x 4" post supports through the bearing and
flush girders, along with the east joist header.
(3) Installation of metal joist hangers on all flush girders.
(4) Lag bolting of the west joist header into the house sill plate.
(5) Reconstruction of the two stairs to create even riser heights.
To the best of my knowledge, belief and judgment, the drawing of the deck,
SK2001-3, dated 9/26/01, represents the as-built condition. It also conforms to
acceptable engineering practices and the New York State Building Code.
Sincerely,
Robert O'Brien P. E.
BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: L4LC-/O1
.DATE SUBMITTED:/zc-/O1
APPLICANT NAME-
SCTM# DISTRICT: 1.000 SECTION://,' BLOCK:_ LOT:
STREET: Q✓ 5?.�i"OCI:, AMC, CITY:A,142uzlX^ SUBDIV. NAME:
PROTECT DESCRIPTION:
ARCHITECT/ENGINEER: FAST TRACK? s
SINGLE&SEPARATE CERTIFICATION-REQUIRED? Wo NOTES:
LOIS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LATS FROM JAN.1997100-25.Merger.(A nonconforming at any time after 7/1/83)
ZONING DISTRICT: R qo CONFORMING? 16S
801 ISU
REQ. LOT SIZE: 46,,000 ACT. LOT SIZE: REQ. LOT COV. A ACT. LOT COV. 3016
REQ.FRONT 50 PROP. FRONT �✓ � REQ SIDE 15/35 ACT. SIDE -t/00 /,=y
REQ.REAR sv PROP. REAR 80
WATER FRO ? Ala DESCRIPTION:
PANEL #: ';�- FLOOD ZONE: ,
A.pp �Ce c.o•
AGENCY PERMITS REQUIRED FOR REVIEW
APPROVALS RE UIRED:
SUFFOLK COUNTY HEALTH DEPT: YES o , ED#): DTE:—/—/ PERMIT#:R10- A"109
NEW YORK STATE DEC: FRE-DEC 9/1/75 YES 0'01 1 TO
SOUTHOLD TOWN TRUSTEES: Yu or
TOWN ZONING BOARD APPROVALIPO
TOWN PLAN. BOARD APPROVAL: YES o
TOWN HISTORICAL PRE (SPLIA): YES o
NYS ENERGY: YES OROtalN�
EGRESS (18 H min.?4 sg ) VENT(SQ. FT. x 4%) ^' LIGHT(SQ. FT. x 8%) iv
BUILDING PERMITS OPENZE D: BP--,�1.1 O -Z/C/0 Z-,2R 4 lb
HAVE PRE CO'S : Y OR N BP -Z/C/o Z- ,
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR : /e,' SF
SECOND FLR : SF INIT OTHER TOTAL
TOTAL: 6/4(v SF FEE FEE FEE
OT( ul/� SF)- ( . SF)= SF X$ =$ — +$ ,� + � _$ �c
STATE OF NEW YORK )
) ss:
COUNTY OF SUFFOLK )
OI'a4zo.o-.being duly sworn, deposes and says:
That deponent is over the age of 18 years and resides at
2c17¢ A-v,>t,e� �•
That on the.Z.:E day of -S/tP T • , 200011 deponent arch itect/engineer,
licensed by the State of New York, hereby states that s/he accepts full
responsibility for the accompanying plans compliance with the New York State
Fire.Prevention and Building Code (9 NYCRR); said plans pertain to property
located at SCTM# 1000- /<S
street address }1725.
Architect/Engineer
Sworn to before me this
lr-�day of , 2001.
Notary Public CARUNO
&Y o.OICA60ta746w
al ied in Suffolk County
ExQin�Jawary 1si ?A�+3..
cc: Applicant
v
nowC
John or formerly to N
J Miska
000
83
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V "-
1 236.261 LL
Area 8000
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S.88°22'36"W. 175.00 300'!
F F O L K AV ESV O'� NE of
NEW SU .�� W.
wy
458
LANA 5
SURVEY FOR
THOMAS D. GOELLER 81 SHARON W. GOELLER
OCT. 31, 1994
APR 7,1994
AT MATTITUCK DATE: DEC. 29, 1993
TOWN OF SO UTHOLD SCALE: I "= 50'
SUFFOLK COUNTY, NEW YORK N0. 93 -0977
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS CERTIFIED TO t
SURVEY M A VIOLATION OF SECTION 7209 OF THE THOMAS D. GOELLER
NEW YORK STATE EDUCATION LAW SHARON W. GOELLER
*COPIES OF THIS "VEY NOT BEARING THE LAND
Sm
VEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL GREEN POINT SAVINGS BANK, ITS
NOT Bt CONSIDERED TO BE A VALID TRUE COPY SUCCESSORS AND/OR ASSIGNS
*GUARANTEES INDICATED HEREON SMALL RUN ONLY 10 NATIONS TITLE INSURANCEOF
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT
THE PERSON FOR TO THE SURVEY IS PREPARED NEW YORK, INC.
AND ON HIS BEHALLFF TO THE TITLE COMPANY,GOVERN-
III NEAREST 1tATj
1/A►EIAIH MI.! II SOURCE Of WATERT PRIIATE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
M SIFF CO. TAX DMi"WISECTION 115 BLACK_3_• OT_t.�.. HEREON,AND TO THE ASSIGNEES OF THE LENDING
? NTHERE ARE NO DWELLUMIS WITHIN 100 FEET OF THIS�ROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON. TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
II THE WATER SUPPLY AND SEWABE DIMMAL SYSTEM FOR THIS RIM1DENCE OWNERS I
WILL CONFORM TO THE STANDARDS Of THE SUFFOLK COUNTY DEPARTMENT T DISTANCES SHOWN HEREON FROM A SPECIFIC uMEf
OF HEALTH SERVICES. t0 EXISTING STRUCTURES ARE FOR A SPECIFIC
AF HEAL H PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
PROPERTY LINES OR FOR THE ERECTION OF FENCES
ADOREfi
nLYOUNG a YOUNG RIERFEADAVENUE
,NEW YORK
NOTE= ♦ = STAKE FOUND ALDEN W.YOUNG,PROFESSIONAL ENGINEER
RE : LOT I , MINOR SUBDIVISION .FOR"SET -OFF AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
JOHN J. MISKA" HOWARD W.YOUNG, LAND SURVEYOR
Irt THE LOCATION OF WELLMI,SEPTIC TANK(ST116 CESWOOLS(CP)fHOMN H"90" L N.Y.S.LICENSE NO.45893
ARE PROM f1E1.D O9KW%TIOPS AND OR DATA OBTAINED FROM OTHERS
8RANOIS 4 BONG INC.
/7 Li `
AP RO ED AS NOTED t. -
n73G�a
/
DA B.P.#E � ,� �' ,� G•rc,.. ,J-[, K .
FIS x,10,Cc> �xvv/
.NOTIFY BUILDING DEP M TAT 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED ..�; Co 'rG - °'- -- j 1�� ¢ -- --
FOR POURED CONCRETE a n
I ROUGH - FRAMING & PLUMBING
& INSULATION
4, FINAL - CONSTRUCTION MUST �oi�-+L /�i�.c 06�-►'G ! v l
I
BE COMPLETE FOR C.O. _ j
ALL CONSTRUCTION SHALL MEET k ; j ti`' k G
THE REQUIREMENTS OF THE N.Y. '
STATE CONSTRUCTION & ENERGY3
"
CODES. NOT RESPONSIBLE FOR � ' L '� acFAI
` ¢
DESIGN OR ONSTRU - — y^"0 eK 3S" 1 ! ,
Y'
i
f
3G'<
Ely
1
f
�0 of N OCCUPANCY OR
Coo
P
F. N.'ROBERT O'BRIEN P.E.
- USE IS UNLAWFUL
r
WITHOUT CERTIFICATE CONSlJLT11VC3 ENOINEEAtNO 8ERVICE8
�e►Z 2�v Main Road, Laurel, N.Y. 1194e
Fp ° 05211'�k OF OCCUPANCY�`
ARoFESS10NP� DWN Q y / 7.?J' �OA'3,v s4r XQ •f w.f.:
' SCALE /✓ DRAWING NO. SHEET
OF .I