HomeMy WebLinkAbout28458-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29824 Date: 11/07/03
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property: 2245 MARLENE LA LAUREL
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 144 Block 3 Lot 13
Subdivision Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 4, 2002 pursuant to which
Building Permit No. 28458-Z dated JUNE 13, 2002
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 ENCLOSED PORCH ADDITION, ADDITION AND ALTERATIONS TO AN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DONALD W & LINDA S MORTIMER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 70012C 06/04/03
PLUMBERS CERTIFICATION DATED 10/27/03 THOMAS AZZARA
i
ut rize 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. 28458 Z Date JUNE 13 , 2002
Permission is hereby granted to:
DONALD W MORTIMER
2245 MARLENE LANE
MATTITUCK,NY 11952
for
ALTERATIONS AND ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
at premises located at 2245 MARLENE LA MATT/LAUREL
County Tax Map No. 473889 Section 144 Block 0003 Lot No. 013
pursuant to application dated JUNE 4 , 2002 and approved by the
Building Inspector to expire on DECEMBER 13 , 2003 .
Fee $ 594 . 00
Authorized Signature
COPY
Rev. 5/8/02
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 I% 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$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. Copy of Certificate of Occupancy- $.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial $15.00
Date. ISP O V. - . d 0 0 3
New Construction: Old or Pre-existing Building: ✓ (check one)
Location of Property: ,;) o> LE ME 4 /V,., /4,4 T l/TV CK
House No. Street Hamlet
Owner or Owners of Property: D O AJ4(-) A j D L.�/U 59 M OR-I I M 6/L—
Suffolk County Tax Map No 1000, Section Block 3 Lot Is
Subdivision ?p Filed Map. ^ Lot:
Permit No. O)g y S $ Date of Permit. - I J- d a- Applicant: 0 )/(11-) & Q V-1/fN rA,
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $
pp icant Signature
�grlFFot,(4,
d+ x
Town Hall,53095 Main Road • Fax(631)765-9502
lTelephone(631)765-1502
Southold,New York l 971-0959 y, * .����
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: OC-1 1 90 C
Building Permit No. <� /
Owner: Dona I M f
(Please print)
Plumber: )1 oweg S Z ZCZ
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
(Plumb ignature)
Sworn to before me this
day of 20
ANNIE E, of of NaNe
Notary PubUc 8tata wlbrk
No.OltS5078083
�' I' Qualgied In Suffolk County
NotaryPublic, J IBJ t1 LCounty Commission Expires May 19,2007
Electrical Inspection Certificate
Issue Date Electrical Inspection Service, Inc. Application Number
06/04/2003 375 Dunton Avenue 70012C
East Patchogue, New York 11772
(631)286-6642
Issued To: Mr& Mrs Mortimer
Street: 2245 Marleane Lane
Village: Mattituck Zip: 11952 Town: Southold
Section: Block: Lot:
Contractor: Tortora Electric Lic. # 3968-E
Was examined and found to be in compliance with the National Electrical Code.
❑ Commercial ❑ NV Defects ❑ Pool X 1st Floor ❑X Indoor ❑X Basement ❑ Hot Tub
X❑ Residential ❑ Det. Garage ❑ Attic ❑ 2nd FloorX❑ Outdoor ❑X Addition ❑ Survey
+. Switches Receptacles Fixtures GFI Heaters A/C Fans
27 34 25 7 6
"ck - Dishwasher WasherlAmps DryerlAmps Oven Range/Amps Microwaves
1-20A 1 20 1 20 1 gas 1
= Furnace Oil Gas Circulators Smoke Detector Bell Transformer
w' 1 x 3 5
Meter Amps Phase UG/OH Jacuzzi Television CO Detector
Bldg. Permit:
Other Equipment
Hugo S. Surdi
President
Rough Inspection: 12/03/2002
Inspector: Ed Scavelli
Final Inspection: 2003
Ed Sc
Inspector: Ed Scavelli
This certificate must not be altered in any manner. Inspectors may be identified by their credentials.
Applicant/
Owners Name: D• m � Date
Lti•L� i ;I Reviewed: (d doh
Architect/
Cngirteer: Td���p,;=, Subrtiitted: �X �
SCTM #:
District: 1.000 Secljon: L -f— Block: �— l,ot:
Project Subdivision
Location. c2,=,2 �� ; _��— Name:
Sin&le & separate Required _//
certification: (Yes/No) .44?A/ ,
+
Req.
Req
(I.olsize: _nf: _7oningOisrid rQ lcuaLl --
(Lot covcra6c I rop<scc
2` r q• R s r •�
((�9oolfl'ard �CJ�( Proposed (Side Yard Proposedn� n J (Rear Yard J /
Proposed
t
z roposed y.
Project Description: (/
AGENC2KRE MUS Permit
RQUIRED FOR-REVIEW -.A. NO Number
Suffolk County Health-Dept-
New
ealthDept.New York State D. E. C.
.Town Trustees
Town Zoning Board..approval:
Town Planning Board approval:
Flood Plane Elevation???
Flood Zone. and"'.61
Dotes: - f
DONALD G.2t$Q • ARCHITECT
11725 Main Ra•Bax 1692•MatMuck..NV 1452+�69l298 5453•Fax 2981380
v��o
June 10, 2002 :
n
i
Mr. Michael Verity, Building Inspector `` ✓
Southold Town Building Department
Town Hall, Main Road, Southold, NY
Re: Proposed Addition to the Mortimer Residence
2245 Marlene Drive, Mattituck, New York
Dear Mr. Verity:
1 have investigated the existing sanitary system at the above mentioned project,
and can verify that its capacity is adequate for the proposed additions to the
existing single family dwelling.
I thank you for your consideration to this matter.
Very truly yours,
al{e
t V u
A
�� 0158v"b �e
ass-i8o2
BUILDING DEPT.
NSPECTION
[ FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ]
FIREPL CE & CHIMNEY
REMARKS:
S/-
DATE INSPECTOR
suaoiNa DEPT.
INSPECTION
[ J FO DATION 1ST ( ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE CHIMNEY
REMARKS: !
DATE INSPECTOR
pus-saoz
suauiNa oar.
INSPECTIO"--
[ ] FOUNDATION IST [ ROUGH PLBG.
[ ] F DATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
elf
DATE fl INSPECTOR
saLuiNa DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROU PLBG.
[ ] FOUNDATION 2ND SULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: � �t�!
DATE �� INSPECTOR
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] RO H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
( ] FIREPLACE & CHIMNEY
REMARKS:
DATE � 03 INSPECTOR �, �
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING ( FINAL
[ ] FIREPLACE & CFIIMNEY
REMARKS: CO
DATE az INSPECTOR
FIELD INSPECTION REPORT DAJF CoArdEm
FOUND9TION(1ST)
y
AO
a
C
FOUNDATION(2ND)
z
it o
z
ROUGH FRAMING& y
PLUbIEING
r
x
a
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r
INSULATION PER IN.Y.
STATE ENERGY CODE
0
FINAL
ADDITIONAL CONIIYTEM
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mm
h ry
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x
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TOWN OF SOUTHOLD '-- `'i BURRING PERMIT APPLICATION CHECKI
BIIILDING DF PARTNRU i Do you have or need the following,before appl:
TOWN BALL J A � ! Board of Health
SOUTHOLD, 1 ori __J 3 sets of Building Plans
91-DG. i)WrT. Planning Board approval
TEL: (631) 16 1802r of Survey
FAX: (631) 765-9502
PERMTTNO. H�45�, Chock
Septic Form
N.Y.SM.E.C.
Tmstees
Examined 6 /D,20� Contact
Approved �T,20 D,.�- Mato:
Disapproved a/c
Phone:
Expiration t I✓' 20 D3
Building
mn(Ar�,
APPLICATION FOR BUH DING PERMIT �y
Date �y `7 200
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 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 we rk covered by this application may not be commenced before issuance ofBuilding 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,
i 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.
(Signature of applicant or name,if a corporation)
ajyC14- vi- rrie L/v,, 1gRrrn-vr—i
(Mailing address of cant)
State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Q W W c Y1_—
Name of owner of premises D O lU A ,- o bi . Fg L i N ba � , M d 2 r l M "—
(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 ( J Hamlet
County Tax Map No. 1000 Section y 7 Block 3 Lot L 3
Subdivision Filed Map No. Lot
(Name)
State existing use and occupancy of premises and intended a and occupancy of prop7d construction:
a. Existing use and occupancy Iz sl a c'N 0 E /v G F FAn/ I y 1
b. Intended use and occupancy
Nature of work(check which applicable):New Building Addition ✓ Alteration—v//' —
Repair
lteration ✓Repair .Removal Demolition Other Work
,yy (Description)
Estimated Cost 4r S U1 O O o Fee
(To be paid on filing this application)
If dwelling, number of dwelling units G k c Number of dwelling units on each floor
if garage, number of cars O /v 6
If business,-commercial or mixed occupancy, specify nature and extent of each type of use.
? I `f'
Dimensions of existing structures,if any Front �7 t Rear 57 Depth 31
Height a �t Number of Stories o x
Dimensions of same structure with alterations or additions: Front 67/ + Rear G 7/ -r
Depth � r Height Number of Stories a
+ p/ +
Dimensions of entire new construction:Front � " - Rear 67 r - Depth + f I
Height d d r t Number of Stories 0 Nc5-
Size of lot: Front /0 0 1 Rear /00 Depth
3. Date of Purchase y-71' 0 Name of Former Owner SJR/�Z L. E 7-0 A/
1. Zone or use district in which premises are situated.
2. Does proposed construction violate any zoning law, ordinance or regulation?YES_NOV�-
3. Will lot be re-graded?YES_NO ✓ Will excess fill be removed from premises?YES L/40-
4.
/ NO4. Names of Owner of premises! �.,bj, MO2T/AVr address I4A rT/r u c lc Phone No. 07 V a 6 ed
Name of Architect AD w,4 D :'E/4 E0,L Address /t�TT/t u c� Phone No S ft- Sy �;-3
Name of Contractor Address Phone No.
5 a. is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* 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
* IF YES, D.E.C. PERMITS MAYBE 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 sure ey.
TATE OF NEW YORK)
SS:
70UNTY OF )
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
S)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
erformed in the manner set forth in the application filed therewith.
wom before me this
day of U-") et- 20 O 2
Gv
Notary Public Signature of Applicant
ELIZABETH A STATHIS
NOTARY PUBLIC,State of New York
No.01 ST6008173.Suffolk County
Term Expires June 8.20.Q7/
N/F ' FLANAGAN
F
N 69' 20' 50" E 147.33' mi Eo.5ARTLEY RD.
FD C CavC. voewAV.. eNo sielorag (PRI VA TE)
0 40.00 J75. I o N/F MAURO
0
O ASPHALT DW GARAGE
� ^
34 ao LOT 8
—J I1 STORY
Eta li J
WOOD
o MAP OF
FRAME
r LIDA BARTLEY
h RES.
�1 � FM# 770
j n43.4; z..X oFILED 1UL Y 21, 1922
N
2 N ENO FfNC£��
N 0.4'
W 7.1" AV
o S 69' 20' 50" W 147.84' �
t�
N/F McASSEY
w
TCmFD
PECONI C BAY BLVD.
SURVEY OF SURVEYED 22 MARCH 1999
SCALE 1"=30'
BESCRIBED PROPERTY AREA- 14,758.261 Sf
TM 1000-144-03-13 OR
SITUATE 0.339 ACRES
MATTITUCK, TOWN OF SOUTHOLD
Guarantees indicated here on shall run r "
only to the peracn for whom the survey
is preocred, and on his behalf to the
�;tb: rempcns. Povern,entcl 'Ag eney,
If sed h:raon, and SURVEYED FOR JOSEPH F. SINGLETON
tha c s rocs of tha lendi;:.7 institution. MARY LOU SINGLETON
Gucresteas are net trans'cr;:hle to
odditbnal institutions or subsequent owners
GUARANTEED TO SURVEYED BY
JOSEPH F SINGLETON
MARY L.OU SINGLETON
CHI CA GO TITLE INSURANCE CO STANLEY ;1. 1SAKSEN, JR.
TOWN OF SOUTHOLD P.O. BC#' _2.8d
NEW. t,f ALF f 19956
Unauthorized alteiaiion or addition to thisCopies of this survey map not bearing
survey iz a violation of Section 7204 o% the Land Si-
lid
embossed sent shall 10E'�1�y L
the New York State Education Law, not be considered to be a valid tNe N/ Y,S t �' - YOR
copy, F784
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LLOWING INSPECTIONS:
PM FOR THE
.
2>La sLEt�'R Bfcopper tubing is use FOUNDATION - TWO R ED
�. for water distributing Q
9 I FORPOUREDCONCRET Y-
em;piping shell be! ROUGH - FRAMING PL INO n
ALL PLUMBING WASTE of types K or L only. i INSUWTION 0UI
PLUMBING � � FINAL • CONSTRUC 1 MUST
NEW &WATER LINES NEED NDER fIC MPLETE FOR C.O
�k1sTINy #�CSEMEtiT CRowIL
TESTING BEFORE COVERING U WRITERSCERTI ATE BECO
- -_- _— - - - __ v I REQUIRED ALL REQUIREMENTS
CONSTRUCTIONS ALL MEET
`7,\ \ I I � THE REQUIREMENTS OF THE N.Y.
/'' STATE CONSTRUCTION 8 ENERGY
PROVIDE ANTI-SCALD AND/OR CODES. NOT RESPONSIBLE FOR
+1
-----___—__-__----- ------_---�----^------ ---- ------�— THERMAL SHOCK PREVENTING DESIGN OR CONSTRUCTION ERRORS _
_ DEVICES AS TO PART. 902.6(K)
L_ C- G� 1= ll )G, E T . N.Y. STATE BUILDING COD�yE3GYsoDEs.QMZ II OCCUPANCY OR
- , CoDesign by
eorrawwuwm �walwwnn(o=416
ISUNLAWFUL
w New Yea Sole Conservation Cana
ComWill require Sell MWW thMmnUCERTIFICAT
PRbffDE- � HR. FIRE building envelope dealpn shall be m 4u than zoro. OF
�1
OCCUPANCY
Fo-N �ua11 -�w, c1, -urfr ToYE,- i_ 26fCRATF*PARATIONTO
_ Thermal
y I a O c, sM^tet. T=�l�-�`f%'F' .I_ti�=PAR'r717.3 (f) (1) OF Area U lue Raft Table Iij
Not Walls 1'�BSSF 044 h�24 6"t
�.,aL — iu _e i _. _ N,Y. STICTE BUILDING CQNI&dng 33b 3" yq GSI
6 DOpn
7—
PROVIDE SMOKE-DETECTI NGRooficeiling
PRDVIDESMOXE-DETECTINGRooncealnq 236e
-ALARM DEVICES Sky ghla 0 5 o_ro
��--� AS TO PART. 721.1 noon
Y.S BUILDING CODE. ' 6z
N• Total Thermal Rallnq o(BullOinq Enw,bpe �j ^� O ^
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3. �N�I r-1F-#,ccs wMtf.r=:c= T� eE i°c.;���I �,'•,�i E - o K IoF EMERGENCY ESCAPE AS DO NOT PROCEED WITH
A T7�'ornlo-V-, ��1 � 7o F,F, D1, ; 41 , REQUIRED BY PART. 714 OF FRAMING UNTIL SURVEY
or GE , �F , _ - N.Y. STATE BUILDING CODE. OF FOUNDATION LOCATION
HAS BEEN APPROVED.
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