HomeMy WebLinkAbout27192-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28332 Date: 04/12/02
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property: 715 DAWN DR GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 35 Block 5 Lot 16
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 16, 2001 pursuant to which
Building Permit No. 27192-Z dated MARCH 29, 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 ADDITION & ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to HELEN E BRENEISEN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. PENDING 04/11/02
PLUMBERS CERTIFICATION DATED 04/01/02 PECONIC PLUMB.& HEATING
Authorized Signa re
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. 27192 Z Date MARCH 29, 2001
Permission is hereby granted to:
HELEN E BRENEISEN
238 DOGWOOD LANE
MANHASSET,NY 11030
for
ADDITION AND ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR WITH TRUSTEES AND DEC APPROVALS .
at premises located at 715 DAWN DR GREENPORT
County Tax Map No. 473889 Section 035 Block 0005 Lot No. 016
pursuant to application dated JANUARY 16, 2001 and approved by the
Building Inspector.
Fee $ 643 . 70
Authorized Signature
ORIGINAL
Rev. 2/19/98
Form No.6 �� (, 1
TOWN OF SOUTHOLD 1
BUILDING DEPARTMENT 22 1
TOWN HALL ,_..
765-1802
APPLICATION FOR CERTIFICATE OF OCCUP CY-7,,"
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 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 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
Date. f-7pr ( Y. J.00 62J
New Construction: Old or Pre-existing Building: ✓ (check one)
Location of Property: I s-/ 00-W n tjf
House No. )) Street Hamlet
Owner or Owners of Property: I?Cj e e) k. (3(en e-i de r- )
Suffolk County Tax Map No 1000, Section 0 3 Sr Block 6005 Lot a/
Subdivision CI1oint Filed Map. Lot: rJl
Permit No. 3-,�-0 / Date of Permit. 91 r/;Z Applicant: `J ph n der 4r n ; /J LJ,�-T,c_
Health Dept.Approval: Underwriters Approval: V/
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: V (check one)
Fee Submitted: $
Applicant Signature
CO aS33�
A
o�o$uFFot,��,
Town Hall;53095 Main Road WFax(631)765-1823
P.O. Box 1179 .ji O�� Telephone(631)765-1802
Southold,New York 11971-095941
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: / 61�
Building Permit No. 6� ?I q Q
Owner: el n Owe i s e i✓
(please print)
Plumber: lAmnlr aM I!N t� ��/e� //v(
(please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
ri
(Plumb(rs Signature)
Sworn to before me this J/_
day of 20o_
Notary PufiBARA SSte PNOWN ow
ak
No.01 T4944752
Qualified In Suffolk County
Commission Expires Sept 30,L2,fAj
Notary Public, County
it by: KENYON&KENYON 2124255288; 01 /04/01 10:44AM;Jetfax #881 ;Page 2/2
New York State Department of Environmental Conservation
Division of Environmental Permits
Rm 121, Building 40-SUNY
Stony Brook, New York 11790-2356
Telephone (631) 444-0365
Facsimile 63 ) 444-0360
John P.Cahill
Ccxtre�'
LETTER OF NON-JURISDICTION
Albert J. Breneisen
238 Dogwood Lane
Manhasset, NY 11031
Date: December 26, 2000
Re: 1-4738-02780/00001
Breneisen Property
71 Dawn Drive
Greenport, NY
SCTM #1000-35-5-16
Dear Mr. Breneisen:
Based on the information you have submitted, the New York State Department of Environmental
Conservation has determined that:
The proposed garage construction shown on the survey prepared by Anthony W. Lewandowski on
8/30100 and last revised on 9/7/00, is landward of the top of the embankment in excess of 10 feet
in elevation, and therefore beyond the jurisdiction of Article 25 (Tidal Wetlands).
Therefore, in accordance with the current Tidal Wetlands Land Use Regulations(6NYCRR Part 66 1)
no permit is required under the Tidal Wetlands Act . Please be advised, however, that no
construction, sedimentation,or disturbance of any kind may take place seaward of the tidal wetlands
jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that
all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance
to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your
project. Such precautions may include maintainingg adequate work area between the tidal wetland
jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a
temporary fence, barrier, or hay bale berm.
Please be further advised that this letter does not relieve you of the res obtaining any
necessary permits or approvals from other agencies.
Vey Y
� o s,
rY
John A. Wieland
Deputy Permit Administrator
MHP
y
Albert J. Krupski,President t1';�QS1I rOC��;' t Town Hall
James King,Vice-President '` "` �Gy t 53095 Route 25
Henry Smith P.O.Box 1179
Artie Foster cn 2 Southold,New York 11971-0959
Kon Poliwoda v� ,!`F �� Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
January 11, 2001
Mrs. Linda D. Bertani
John Bertani Builder Inc.
1380 Oakwood Dr.
Southold, NY 11971
RE: ALBERT J. BRENEISEN
71 Dawn Drive, Greenport
SCTM#35-5-16
Dear Mrs. Bertani:
The Southold Town Board of Trustees reviewed the survey dated August 30, 2000 and
determined the construction of a 10'X 22' garage addition to be out of the Wetland jurisdiction
under Chapter 97 of the Town Wetland Code.
However, any activity within 100' of the Wetland line would require a permit from this office.
This determination is not a determination from any other agency.
If you have any further questions, please do not hesitate to call.
Sincerely,
e?
'e4�� 0 f • i
a '- ;�
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:Ims
BUILDING PERMIT REVIEW CHECK LIST
n DATE REVIEWED: 3 >I 161APPLICANT NAME: Ogre_-Jr>ser, DATE SUBMITTED:-Z_//A /_0L
SCTM# --- DISTRICT: 1,000 SECTION: 3 % BLOCK: S LOT:
PROJECT LOCATION AND TYPE OF PROPOSED WORK:
PROJECT DESCRIPTION• ADD ALT ACC OR N/D: 74 �,�cte o �� �•.•. ��4� ��
STREET: 7/ate �J a�- /J r•ve, CITY: SUBDIV. NAME: /�a°-s /7L
ARCHITECT/ENGINEER: FAST TRACK: YES oR
SINGLE & SEPARATE CERTIFICATION-REQUIRED: YES o NO OTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LO OM JAN.1997 100-25.Merger.(A n onforming at any time after 7/1/83
ZONING: PERMIT ESTIMATE AMOUNT:_$ -2-n 70a .00 PERMIT USE: EXISTING: S� INTENDED: XvlsJT
ZONING DISTRIC R4 80 AC CONFORMING: YES OR NO REQUIRED LOT SIZE: SQFT.
/&Coo tu.v.y
WHERE ACTUAL LOT SIZE FROME�QQ�LMED
ACTUAL LOT SIZE:�^�SQFT.
REQUIRED / REQUIRED �g r
FRONTX� 'PROPOSED: 19 SIDE YD: /6 V a?< ' PROPOSED:.2-0,?'/ REAR:3S 'PROPOSED244'
LOT COVERAGE: OWED:% EXI G: �5f % NEW: sf_% TOTAL oSs o
CORNER? YES o N WAT ER FRONT? YE oR NO DESCRIPTION
SU•,,�r f�� Z�
FL9/OD COMPLIANCE ZONE: PRE-FIRM 3/18/80 PANEL #: /7G FL ZONE:_
�a..
AGENCY PE S REQUIRED FOR REVIEW
Q INCLUDED IN APPLICATION
TOWN SPETIC PERMIT: YES or NO
SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED : DTE:—/—/ PERMIT#:R10-
NEW YORK STATE DEC: PRE-DEC glim �or
NO
SOUTHOLD TOWN TRUSTEES: SNO o 'x-2,>
TOWN ZONING BOARD APPROVAL:vs
TOWN PLAN. BOARD APPROVAL: YES o NO
NYS ENERGY: YES OR NO EGRESS: VENT LIGHT:
NOTES:_
u l/ af 4/SX- /39 ft��
.6 oft
E TRUCTURE: FOUNDATION: SF <<,lA� I &J vY e `: o°.,
FIRST FLOOR : 9-152 SFsX40 o - i+07�
SECOND FLR : /S , SF KIT �OTH4 TOTAL
TOTAL: 34"f, S SF FEE FEE FEE
T( 34 63.,!5 SF)- ( SF)= ?-;4a,Z SFX $ -Zo =$ S4F)U +$ $ 64_t-,>d
:J
765-1802
BUILDING DEPT.
INSPECTION
[ ] UNDATION IST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ J FIREPLACE & CHIMNEY
REMARKS:
may`
DATE Z1 INSPECTOR
-7/
T65-1802
BUILDING DEPT.
INSPECTION
[ j FOUNDATION IST [ OUGN PLBG.
[ ] FOU TION 2ND [ ] INSULATION
[ ING [ ] FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
�O D
0
DATE m IN8PECT0 01
suauiNc oar.
INSPECTION
[ ] FOUNDATION iST [ ] RO PLBG.
[ j FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREP CE & CHIMNEY
REMARMyF41�����-G!n
v
-3f
leo
DATE ` / INSPECTO
suauiNc DEPT.
INSPECTION
[ ] FOUNDATION IST [ j ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 CATION
[ ] FRAMING [ FINAL
[ ] FIREPL IMN Y
REMARKS��
DATE O INSPECT0
FIELD INSPECTION REPORT DA _ _COMMENTS
--------- u — ---
H
FOUNDATION ( 1ST)
FOUNDATION (2ND) n 11___— ----__----
In _ii o
ROUGH FRAME &
n
PLUMBING ii u w
n II
--------------------------
INSULATION PER N. Y. iirid
STATE ENERGY II p36
CODE f
ii
u
If a
------- a ---- n
--------- n if
II jj H
tzj
11 j
FINAL
ADDITIONAL COMMENTS:
/1/i/1 4-,sa.e.� 1..m/+ xi.., 6'js� 4e., ..� �t�•�r C� c .-F bs,9a/.,V/ff/
Q C ev�� ¢ ��(T%F►t����. �iy /G(rJ , /N/,
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H
ORM NO.3
_ TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
i aEa• f SOUTHOLD,NY 11971
TEL:'765-1802
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
Examined
Approved 2001 PERMIT NO.
Disapproved.a/c
BuildintInspector
APPLICATION FOR BUILDING PERMIT
Date ,,�on , 200
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets.-of plans, accurate plot plan to sale. 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 of this application.
> 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 whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector .
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.
.�0INn 13G'deni c�uAIdtr T v
(Signature of applicant or name,if a corporation)
i 3&O 0c4_AA00,L Or, 4 d"*o Ld_. l�r
(Mailing address of applicant) 11Ctl
State whether applicant is.owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
'Name of owner of premises Rf bt+ GLA L 4e.1 c'n f3('Cnle1 JC/'")
(as'oh the'tax roll or latest deed)
If applic t is a co orati , signature of duly authorized officer
ame and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No..'
Other Trade's License No.
1. Location of land on whichd work will be done:
1 proposeOr�
House Number Street Hamle
County Tax Map No. 1000Section 3� Block Lot D
Subdivision (i��U,11�t,a i961 t . etc,• Filed Map No. Lot 171
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Ogle lr;4Prr 4Y Z>W a eA.','
b. Intended use and occupancy It
" to
3. Nature of work (check which applicable): New Building Addition ✓ Alteration
Repair Removal Demolition Other Work
,� (Description)
4. Estimated Cost— ,?9q,qo . Fee
(to be paid on filing this application)
5. If dwelling,number of dwelling units / Number of dwelling units on each floor /
If garage, number of cars 2-
6.
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front -:57-6 Rear 5 Depth 24, f ,olv
Height /4. " Number of Stories /
Dimensions of same structure with alterations or additions: Front S Rear S8
Depth 2B -r- 50 Height 2 to' Number of Stories i /Z
8. Dimensions of entire new construction: Front ;:p 5 f 2--a Rear o Depth
Height .2 Number of Stories
9. Size of lot: Front I(19 Rear Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated !SCJ)&LA+16' 1
12. Does proposed construction violate any zoning law, ordinance or regulation: h 0
13. Will lot be re-graded i1 O Will excess fill be removed from premises: YES NO
• n- m(AA hcuTc • /lv3 I
14. Names of Owner of p mises E}ll�c& Ig(tJlel tuy Address &43? 60 p d,LA . Phone o.,S"Y621 ssa y
Name of Architect n G . Address ar cL v l�i��r� o 4/ 40
Name of Contractor 19 114e Address cL r' Phone No.
l•L
15. Is this property within 300 feet of a tidal wetland? *YES ✓ NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
16. Provide survey, indicate scope of project, to scale, with distances to property lines.
17. If elevation at any point on property is at 10 feet of below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF�
Ln d&_ /�. U � being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the C_,0 h r
(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 therewith.
Sworn to before me this
day ofQV.-- 2001
o ary PublicjOYCE WILKINS Signature of Applicant
Notary Public,State of New York
No.4952246,Suffolk County
Tenn Expires June 12,oZ oG/
I
11 it
WARREN A.SAMBACH,SR.
CONSULTING ENGINEERS•PLANNERS ' LLJJ
7675 COX LANE • P.O.BOX 1033
CUTCHOGUE,NY 11935
6 31-00"34-7492
December 18 2001
Building Department
Town of Southold
53095 Main Road
Southold NY 11971
Re: Albert Breneisen Permit No: 27192 Z
715 Dawn Drive
Greenport NY 11944
SCTM: 473889 Section: 035 Block: 0005 Lot: 016
Gentlemen:
Observation of Addition and Alteration to the existing one
family dwelling located at the above does not exceed the
20% lot coverage according to measurements and calculations
by Anthony Lewandows'tii , Land Surveyor.
Sincerely,
" �rM+w" '4
Warren A. Sambach Sr. P.E.
was: s
iES�n.
A.
APR 1 $ +
,t/G9`o9 5D"E'
75•/9'
v�
� o
` N
unauthorized al or addition ZG,f' ZZ h O 0
to Alis survey is a a /CROP V
$action 7208 a vork Stats
Copies of tN. net beating Q "�l� G•arAG 0 /`
ttte land btbsd seal or ,\ ,
embossed sed not be mtrldMaO h `� /3' I' � a
to be a slid t ttp;y-
Guararrses Immen du1 an �Q� f t�if�•/!'6 //GY M 1� �t� /�/
oroy to ttte palm brwhom Uta atavar l�`` /�1 F/.E!• /7� N
is prepared,and on his Wait b lira 0 �iQ3E/!1b✓Tfl�=9.8 �� .
title company govenwneraw 00srt Y an/
tendirp knout on Iced hsnon andBAND
to the assignees a M Mrtdrq btaMasn N ���n1 Sr�pS
Guaranties an not trartsierabla
to additiorul institutions or atbasgtatett
owners zy W~,VvvG ' I 7—r•'�.i �J A,� `
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UNDERWRITERS CERTIFICATE
AP ROVED AS'NOTED UIRED PROVIDE% HR. FIRE
RED
DI 7 B P # RATED SEPARATION To
1;I�T
FEE' ag� 26. BY: AT N, PART. 717.3(f) (1) OF
NcTIFY'BUILOING DFITIENT PROVIDE ANTI-SCALD ANDIOR Y SIATE BUILDING CODE.
OR THE THERMAL S
765-1802 9 AM TO 4 PM F
FOLLOWING INSPECTIONS: DEVICES PREVENT " iA
AS"T'O PAR
il, FOUNDATION - ,,TWO R D
PROVIDE OPENINGS FOR
RED CONCRETE
FOR POU EQUIRE N Y. STATE BUIL I I- 902W
D XG CC
"N
2. ROUGH - FRAMING & PLUMBING EMERGENCY ESCAPE At 7 t
REQU
3: 1NSU TION
- .CONSTRUCTION MUST 'K'u By PART 714 OF
r -PLUMBING
BE COMPLETE FOR C.O., ALL PLUMBING WASTE N-Y STATE BUlLOlNG_C0DE.
ALL CONSTRUCTION SHALL MEET j,4al
&WATER LINES NEED
Ti-q
TIAE REQUIREMENTS OF THE N.Y. TESTING BEFORE COVERING
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
PLUMBER CERUTICATION
If copper tubin
0, g is used ON LEAD CONTENTBEFORE
for Water distributing CERTIFICATE OF OCCUPANCY
SyStern; piping shall be
OR SOLDER USED IN wA TER
of types K or L only
PANCY
SUPPLY SYSTEM CANNOT 4
� P,,`IS UNLAWFUL UNDERWRITERS CERTIFICATE EYCEED 2110 OFrj%LEAD.
REQUIRED
HOUT TIFICATE
CER
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ROVIDE IF
ALARM-DEVICES
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