HomeMy WebLinkAbout27289-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28405 Date: 05/10/02
THIS CERTIFIES that the building ADDITION
Location of Property: 1556 GRAND AVE MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 107 Block 3 Lot 11.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 5, 2001 pursuant to which
Building Permit No. 27289-Z dated MAY 4, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to KIMBERLY S PROKOP
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Autho Alze Si ture
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. 27289 Z Date MAY 4 , 2001
Permission is hereby granted to:
KIMBERLY S PROKOP
1556 GRAND AVENUE
MATTITUCK,NY 11952
for
CONSTRUCT DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR.
at premises located at 1556 GRAND AVE MATTITUCK
County Tax Map No. 473889 Section 107 Block 0003 Lot No. 011 . 004
pursuant to application dated MARCH 5, 2001 and approved by the
Building Inspector.
Fee $ 75 . 00
AuthorilaA Signature
COPY
Rev. 2/19/98
r
Form No. 6
TOWN OF SOUI'HOLD F�(
BUILDING DEPARTMENT
TOWN MUT
765-1802
APPLICATION FOR CEWFIFICA` E OF OC
This application must be filled in by typewriter or ilk and submitted to the Building Department with the fo o ing:
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 se«verage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Undenvriters,
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of l% lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificat
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. S to -z—
New Construction: Old or Pre-existing Building: (check one)
Location of Property: Ave—- A
House No. Street Hamlet
Owner or Owners of Property: �ot r L y P rld V o P
Suffolk County Tax Map No 1000, Section k 0-7 Block 3 Lot // 00Y _
Subdivision Filed Map. Lot: [�
Permit No. Date of Permit. _Applicant: el-IV r rC.)��P
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ -Z,*?' --
G �j f k Appli ant. Si ture
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSUON
[ ] FRAMING [ NAL
[ ] FIREPLHIMNEY
REMARKS:7
DATE INSPECTO
FIELD INSPECTION REPORT DATE COMMENTS
II H N
FOUNDATION ( 1STY
ifI - 11
FOUNDATION (2ND) __ I
II
II
II
ROUGH FRAME &
PLUMBING I�
II -
--II
INSULATION PER N. Y. ! !'
1 H
STATE ENERGY n
CODE u
if
-41
CrJ
I II H
II jj
FINAL !; 7)
ADDITIONAL COWENTS:
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qBU1LWNU?-b- Mll AePLICA ION (:H CKL15
BUILDING DEPARIMENT Do you have or need the following,before applying
TOWN HALL ° W 5
Board of Health
SOUTHOLD, NY 11971
3 sets of Building Plans
TEL: 765-1802
'��� «�"• �� ., 7� �� � survey
_ JIT NO.�' Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined ,20 Contact:
Approved �CcD 200 k Mail to:
Disapproved a/c
Phone:—3`
Build' g Spector
APPLICATION FOR BUILDING PERMIT
. r _
Date ... , 20`;.
INSTRUCTIONS
a. This application MUST be completely filled in by iypewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings odpremises,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 throti6out'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 Occupan
is issued 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,oralterations 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.'
(Signature of appli t or name, if corporation)
M& kt4u,,C.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect,engineer, general contractor, electrician, plumber or builder
Name of owner of premises 1Z Vty9 e1L Gb l S Pr ck-b p
(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:
House Number Street Hamlet .,
County Tax Map No. 1000 Section /r7 Block 3 - Lot-
Subdivision
Subdivision Filed Map No. Lot
(Name) .
u,c iulu uwupaucy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy�ly�
�. Nature of work (check which applicable): New Building Addition X Alteration
Repair Removal Demolition Other Work
1. Estimated Cost t63L1Jo Fee (Description)
(to be paid on filing this application)
If dwelling, number of dwelling units Number of dwelling units on each floor /
If garage, number of cars 2-
If
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front Rear Depth
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 3�:. Rear 3'1; 1 Depth
Height Number of Stories_ AZA
Size of lot: Front I3;-L(7 Rear N-4-01 Depth
0. Date of Purchase0/15Name of Former Owner f/1�l��
1. Zone or use district in which premises are situated
2. Does proposed construction violate any zoning law, ordinance or regulation: D
3. Will lot be re-graded A JJ Will excess fill be removed from premises: YES
4. Names of Owner of premises AM-i�S p,Q(t, , Address 19Z,64w&4!4w-MA"' �
Phone No. }7 5�-- 35
Name of Architect c�D
�. Address A Phone No
Name of Contractor Ser' -/Kt -._'Address_ �
Phone No. d*7 B - M86
5. Is this property within 100 feet of a tidal wetland? *YESO
• IF YES, OUTHOLD TOWN TRUSTEES PERMITS MAY B 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 OFS
Kip.he,vPro 4,2P being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing con ct)above named,
i)He is the
(Contractor, Agent, Corporate 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;
iat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
-rformed in the manner set forth in the application filed therewith.
wo Inta before me this
day of 20�
otary Public Signa a of Applican
NOTARY PUBLIC Sae of meal,York
No.01806020932
Clualified in Suffolk County
Tem Expires March 8, 20
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NOW OR FORMERLY
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fire existence of right of ways and or easements
of record, if any, not shown are not guaranteed.
AREA 32 , 150 SO. ,FT
sHawN x6v'aN EROM THE s— RU�L�owr ATO ME"1lifWl 'JOBNO. 95-300 FILE NO 535 D
STRUCTURES r0 THE PROPERTY EOR W11@A IHE WRYLY 16 PSE.
LINFL ARE U a SPECIFIC POR. PARED, AND ON ER6 64flQE To SURVEYEDFOR DAVID old KIMBERLY PPOKOP
P06F ANO UPI HNO GUIDEP THE THE 1G 0.l AND WYIRWMF
ER NON OF PENSED TO WAR THE TAT AGENCY AND PON, A IN6TI-
RNE T O6 PENCIL, RETAINING iTE A IGNED HEREON, ANO TO
W/LLT[, RIY[, PATH RANTING THE AUTION, Of THE TENDING
AgiN, flagRLN Ta BYIlgNa6 INSTITUTION. OE TO ADH ARE
ax oll�LorxaE,wREd6.
NOT TUTIONSO ro ,wortroNu
U MNWpIb AAIIRRTKIN a INf�ili�UilONS OR [U[[lWENi
TJ IDII MMPI! 0 A SITUATED AT M AT T I T U C K
cr attllrrT nnI a 0011s of THIS N[AY,• WG Nor
TeN 'frJec IbYIE mT161'RYgI tYARINe TME IAND WRv1FExI TOWNOF SOUTHOLD , SUFFOLK COUNTY N.Y
I.wm. malle PIAL OR 10,45011N uAt
Man It ABY Lp � p N SCALE I" = 30' DATE 9 - 19 - 1995
GUARANTEED ONLY TO OF NE(y FILED MAP NO. - DATE -
DAVID PROKOP 4,111 YOq TAX MAPNO. 1000 - 107 - 3 -114 (REF. ONLY) DISK 142
KI M B E R LY PROK P 15)F. TRANC,yO IF HAROLD F. TRANCHON JR. P.C.
FIRST AMERICAN T BOE Q0 . 0 N.Y LAND SURVEYOR
SUCCESSOR TO WILLIAM G. MEIER
�+[ 1866 WADING RIVER-MANOR RD. WADING RIVER,
'�q ppay- Op NEW YORK, 11792
HAROLD F. TRANCHON JR. �pg�j'N s , N0048992 516-929-4695
AQP "ED AS NOTED
CIATEAk,r-o 1( --F,
FEE
N'0711"'Y BUILDIN
132 9 AM 7" 4 PN' F('W� PENNY LUMBER
PLAN VIEW -O_LOMING '10�1\61
'!JNDATI0N
CUSTOMER - - FRED SEtFERT OR POURED NORTH RD .
!G-H - FR
I-ATION
DATE 02 / 27 / 01 REF Prokop MATTITUCK , NY
( 631 ) 298 - 8559
Th E REQUIREMEN
STATE CONSTRUCTi0N & Ei"'
CODES. NOT RESP()'NS9'�� E
35 DESiGN OR CONSTRUCTION ERROR33 _,!
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LOAD AND SUPPORT: Your deck will support a 53 PSF live load. Posts have below-ground
post support.
DECK AND POST HEIGHT: You selected a height of 24" from the top of decking to level ground.
The top of the deck support posts will therefore be 15.25" above ground level. Your salesperson
can provide Information for uneven or sloped ground.
JOISTS: Set Joists on top of beams, 16" center to center.
NOTE: The design may require knee braces and bridging between joists. Your materials list includes
the necessary items. The suggested design is not a finished building plan. You are responsible for
all measurements being correct, for verifying that the design (and any substitutions or modifications
that you make) meets all local building codes and requirements. To verify that the suggested design,
and any substitutions or modifications, is consistent with conditions at the construction site,
review the design with your architect. Also consult your architect for proper construction and use
of materials in the structure.
Be sure to follow the deck construction detail available from your store salesperson.