HomeMy WebLinkAbout30670-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30508 Date: 10/21/04
THIS CERTIFIES that the building ADDITION
Location of Property: 450 E CEDAR POINT DR SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 90 Block 2 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 10, 2004 pursuant to which
Building Permit No. 30670-Z dated SEPTEMBER 28, 2004
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 EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS
"BUILT" .
The certificate is issued to ALINA WIEDERMAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
c "
Au 1;7e
; Sig ature
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. 30670 Z Date SEPTEMBER 28, 2004
Permission is hereby granted to:
ALINA WIEDERMAN
450 E CEDAR POINT DRIVE
SOUTHOLD,NY 11971
for
CONSTRUCTION OF AN "AS BUILT" DECK ADDITION AS APPLIED FOR
at premises located at 450 E CEDAR POINT DR SOUTHOLD
County Tax Map No. 473889 Section 090 Block 0002 Lot No. 015
pursuant to application dated SEPTEMBER 10, 2004 and approved by the
Building Inspector to expire on MARCH 28, 2006 .
Fee $ 300 . 00
Authorized Signature
ORIGINAL
Rev. 5/8/02
?6S- 3'114
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$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.. 10 191 o�{
New Construction: Old or Pre-existing Building: V (check one) II
Location of Property: S(� �!4(,A po i n f firi v/ CA-SF So .71 u
House No. Street Hamlet
Owner or Owners of Property: �c c t c. L10" QAp(�Nrt V1
Suffolk County Tax Map No 1000, Section 9 D Block Lot s
Subdivision aG\0,^ Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: uf v-4eg0tr rd! Underwriters Approval:
Planning Board Approval: 1Jo I- r p itA ir2 a
Request for: Temporary Certificate Final Certificate: W--, (check one)
Fee Submitted: $
70 �� plicant Signature
Co
56567
1\
' .. r 'TOWN OF SOUTHOLD 1' ORERTY RECORD CARD
OVOOR STREET VILLAGE DISTRICT SUB. LOT
h. /4
FORMER OIEVNER N E ACREAGE
A MO
S W TYPE OF BUILDING
LtJe.�ch, Z Sg'
iES. SEAS. VL. FARM COMM. IND. CB. I MISC.
LAND IMP. TOTAL DATE REMARKS
0 D Soo10
- -�-
_ J
s tt f - 9 O S1 O 0 0
6700 dao e3 a , b -e _ ,,*fQ -i-w.fe �
6-0 laa /6 � a.� f 7 P -gc9s _moo - 9�,
AGE BUILDING CO
NEW NORMAL BELOW . E3OVE
Farm Acre Value Per Acre Value LJ
rilloWe I
Tillable 2
Tillable, 3
i 971Z
vVcodland
iwampland
3rushland
House P)ot "
Total
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 -7.
SECTION A-PROPERTY OWNER INFORMATION For Imstia
t(ae:
BUIL G OWNER'S NAME PON
BtJ LDING S-iirET ADDRESS(in:Audu',;i Ap:.,L'-t S.de,and�LWX No r OR r 0 ROU I r AVD BOX Ni; Company NAICtlJ006T .
��:•off '�,Q,jr�? �-,,,,- i
CITY Sod l� - - STArE ZIPCODE A 7f
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
/aon 90 -oZ ss�
BUILDING USE(e.g.,Residential,Non-res}} ential,Addition,Accessory,etc. Use a Comments area,'d necessary.)
e C°a/D&A*/L-
LATITUDE/LONGITUDE( PTIONAL) HORIZONTAL DATUM: SOURCE: GPS
or ##.gl<1A10) IJ NAD 1927 IJ NAD 1983 U Rte)'
U USGS Quad Map LI Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUTNA7 B3.STAT
P,ori r"'
B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE - ZONE(* (Zone AO, depth of flooding)
169 At>t� g, i99d' I X
B10. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in B9. — �
IJ FIS Profile LA FIRM 1J Community Determined 1_I Other(Describe):
B11. Indicate the elevation datum used for the BFE in 89: 1J NGVD 1929 PC I NAVD 1988 IJ Other(Describe):
1312. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area(OPA)? 1J Yes P9 No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on: "Construction Drawings' I_IBuilding Under Construction' lgFinished Construction
'A new Elevation Certificate will be required when construction of thuiiding is complete.
C2.Building Diagram Number 2 (Select the building diagram mostilar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accurately represents the building, F rrovide a sketch or photograph.)
C3.Elevations—Zones Al-A30,AE,AH,A(with BFE),VE,V1430,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from
the datum used for the BFE in Section B,convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document thedelurwconversion.
Datum NGlrb 1924 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? IJ Yes No
O a)Top of bottom floor Qneluding basement or enclosure) R . ft(P)
O b)Top of next higher floor
O c)Bottom of lowest horizontal structural member(V zones only) AJ 1A _ft.(er) y o `
O d)Attached garage(top of slab) _13 .jrP—ft.(r1 w: '
❑ e)Lowest elevation of machinery and/or equipment
servicing the building(Describe in a Comments area.) 8 .±L ft.(1fo
❑ f)Lowest adjacent(finished)grade(LAG) 13 .3_ft.(d) Z'.0
O g)Highest adjacent(finished)grade(HAG) A it-o j
❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade�— F
❑ i)Total area of all permanent openings(flood vents)in C3.h AJJA sq. in.(sq.ci%�
1
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information in Sections A,B,and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code Section 1001
CER.7TIFISR'S NAME / LICENSE NUMBER !6,
TITLE A (�. n o y4. 5 - t� I7
j JUb B2 COMPASNY E W P .EO
ADDRESS CITY
SIG -TURE - ATE� ZIP CODE
DATE a C TELEPHONE63/ e
FEf7l#Form 81-31,January 20 See reverse side for continuation. Replaces all previous editions
-�ppgOFFO�,�c
Albert J. Krupski,President OV Q Town Hall
James King,Vice-President �� Ty� 53095 Route 25
Artie Foster P.O.Box 1179
Ken Poliwoda 40 Southold, New York 11971-0959
Peggy A. Dickerson Telephone(631) 765-1892
1 J�{ Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 5992A
Date of Receipt of Application: September 16, 2004
Applicant: Patricia Wiederman
SCTM#: 90-2-15
Project Location: 450 Cedar Point Drive East, Southold
Date of Resolution/issuance: September 22, 2004
Date of Expiration: September 22, 2006
Reviewed by: Board of Trustees
Project Description:As-built deck.
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth in Chapter 97 of the Southold Town Code. The
issuance of the Administrative Permit allows for the operations as indicated on
the survey prepared by Joseph A. Ingegno dated July 26, 2004.
Special Conditions: None
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chapter 97 of the Southold Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
A& e � '
Albert J. K pski, Jr., Pres.
Board of Trustees
LlIbTL+ _i7T` T�7��fT"T Thr ! c rrrW L'__�_T�•C�'�7r� ( �T
I JTLL111��_�l L1tJ `111 Itr : �r � T! f—TZ
Applicant/ Date
" Owners Name:.. c�dZ O-f a -�f,/, Reviewed: /3
Architect/ Date
Engineer. Submitted: ' /v
SCTM #:
District: 1.000 Section: .�Q 13 lock: 2 Lot: /S
Project Subdivision
Loca(ion: 5?) !, 6'e' �� 9,0 Name:
Single&separate Required
cc 1 kation: (Yes/No)
. ReqZ• Rcq g
Loving Oislriet:� Ileis1w: -4o2W Amal: /�•u•�° I (l.otcoverage +U b14opscJ l
PCk RN. /S� r Rte.
(From Vard 5 Proposed: (Side Yard , Proposed: (Rear Yard Proposed-�(
Project Description:
AGENC R91IM1TS Permit
REI�IIRED FOR REVIENumber
Suffolk County Health Dept. _
New York State. D. E.C.A)"Xtk 42
Town Trustebs A) ' a
• � Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation???
Flood Zone: —�..� � • ��l Q
4
w
M' 'r Av
/tt�f:
AZ.MV,.3� ..
1
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1 bbe
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"east
Numi
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"- BN�:KNun
N�Fek OUAgAN
,AND TH.
MIMS
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Ra
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i
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El
A. Bldg. 7 _ f 1 Fo tion e" a Bath 3
extension Basement _ T. Floors A?
�+ ++ Interior Finish
ixterision �Walk
extension Fire Place Heat
Porch Attic
�.
Porch Rooms lst Floor
Ireezeway Patio Rooms 2nd Floor
'°rage g X.Z 0. 3 °= b F-o Driveway
). B:
1Z2a7'
7 y 7 ( '
`^MP
pos-r Y
/ / • y •.
ZONE AE (EL 8) f 0 •'-
ZON
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II QON / "•�� S O
QQ _
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\ _ kF? I O I CONC.. GOA
a�
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ZONE'
k+ `\2., 3 \
o:...... ZONE
Y/ �—
�r N
74-34'59„ W
LANDING106.S7'
OD
68e22 LANDING, PREPARED IN ACCORDANCE WITH THE MINIMUM
G 41 S40 BYTHE TDARDS.A.�S. AND APPROVEDR TITLE SURVEYS AAANDSADOPTEDD
�O „/0„ NA1F-q „ N/C N, TITLE FOR SUCH
ASSOCIATION• THE YORK STATE LAND
E PEC�NIC[bq y� ]� y 1
3
3 A 1
N.Y.S. Lic.
UNAUTHORIZED ALTERATION OR ADDITION
SE THIS SURVEY IS A VIOLATION NEW
YO OF Joseph A.. ingeg
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW.
COPIES OF THIS SURVEY AMP NOT BEARING Land Surveyo
THE LAND SURVEYOR'S INKED SEAL
EMBOSSED SEAL SHALL NOT BE CONSIDERED
NOTE: TO BE A VALID TRUE COPY.
FLOOD ZONE INFORMATION TAKEN FROM: CERTIFICATIONS INDICATED HEREON SHALL RUN
CI hnn INIIZI IDAAIrr DATr LJAo M- 2AlnZrnl rQ n ONLY TO THE PERSON FOR WHOM THE SURVEY ^•
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION i ST [ ] ROUGH LBO.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE Q INSPECTOR
N
r I `
FIELD INSPECTION REPORT DATE COMIENTS
uie
FOUNDATION(1ST)
_ C
m
FOUNDATION(2ND)
0
d �
y
ROUGH FRAMING&
PLUMBING
INSULATION PER N.Y. "3
STATE ENERGY CODE
(22
IT
FINAL
ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CrHECK.LIS
BUILDING DEPARTMENT Do you have or need the following,before applyius
TOWN HALL Board of Health No
SOUTHOLD,NY 11971 4 sets of Building Plam �4eS
TEL: (631) 765-1802 Planning Board appmval I4D
FAX: (631) 765-9502 Survoy No —_
www.northfork net/Southold/ PERMIT NO. 3 06 70 7r Check —%-Ie S
Septic Form
KY.SD.E.C.
��_./// Trustees_
^
Examined —-4f=t, 20 Contact.: I -�
Approved20 0 Mail to; :5,4n h/IG�kS J / /�
Disapproved a/c 6 of/P f /?,"/ F,440
Phone:—C,?/-74SW6
Expiration .20
Building Inspector
APPLICATION FOR BUILDING.PERMIT
02004 Date/!) 20P-1-L
I i INSTRUCTIONS
a-'Phls applioattonIV completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scala.Fee according to schedule.
b.Plot plan showing location of lot and of buildings on promises,relationship to adjoining premises or public stress 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 over 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 elate 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 Pormit pursuant to the
Building Zane Ordinance of the Town of Southold,Suffolk County,Now 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.
Qlw4�
(Si of applicant or corporation)
(Maing address oftslrplicant)
State whether applicant is owner, lessee, agent, architect,engineer, general contractor, electrician,plumber or builder
Name of owner of premises FS f0 Jt Vr F X,P)a W i eJer-V4 a t-t
(As on the tax roll or latest deod)
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:
ys() (aa T�16,"4 TJhVf 'Ear;f s C,�4\�-o�d
House Numb4 r Street Hamlet
County Tax Map No. 1000 Section Blocka Lot (�
Subdivision Filed Map No. Lot.
(Name)
1. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy lZes`,Cleo c-r
b. Intended use and occupancy 'nuc k
3, Nature of work(check which applicable): New Building_ Addition Alteration!___.__
Repair Removal Demolition Other Work s A -lawi If Rddi�t.etn
(Description)
4. Estimated Cost -117.31SUD Fee -k 3d0
(To be paid on filing this application)
i. If dwelling, number of dwelling units Number of dwelling units on each floor _
If garage, number of cars
i. If business, commercial or mixed occupancy, specify nature and extent of each type of use. _
7. Dimensions of existing structures,if any: Front 22 8 Rear 22 8 Depth I/ _
Height 'Zr +/- Number of Stories
Dimensions of same structure with alterations or additions: Front _Rear
Depth Height Number of Stories
3. Dimensions of entire new construction: Front___Z_- I S h Rear Z7 r b' !r Depth, 4 !
Height Number of Stories
�. Size of lot: Front 200 Rear ZOO Depth 3 g O
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated Res i cit V, a( R y 0
12. Does proposed construction violate any zoning law, ordinance or regulation?YES_NO�__
13. Will lot be re-graded?YES—NO '2t Will excess fill be removed from premises? YES_..NO K/
14. Names of Owner of premiseshPa tekfrMo,n Address es Cede-T--'-+br. E Phone No. ?6 S-ZV1 I
Name of Architect Address,_ Phone No
Name of Contracto7—CMCJ Cer�slrt cliea, Address\\ &X orPhone No. s( - a
UK
15 a. Is this property within 100 feet of a tidal wetland ora 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 .X NO
* IF YES,D.E.C. PERMITS MAYBE REQUIRED. Ex�sk..9 b Jlsl.<wds 1'+» juc5sd cIi ut1.
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.
STATE OF NEW YORK)
SS:
COUNTY OFA
J_0( vim T being duly swom, deposes and says that(s)be is the applicant
(Name of individual signing contract)above named,
(S)Heisthe F�92nt _
(Contractor,Agent,Corporate Office, etc.)
of acid owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;
that all stNements 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.
Swore to before me is
t o t^� day 20 E 4-
Notary Pu 'c �gnature of App t
RC)aER SCOTT A
Notary P c.State of Naw York
Du ' lad in Suffolk County
No.01 SC472608 Z
T rm Expires May 3t,OE
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-- t Coe P os � � o APPROVED AS NOTED
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4�' - pS:l p„S h '51 zz /,f t iS,ty �l�vl �. �._—+ I F- - 3tJ�. 8DY: lr. ��
-IFYEBUSI AMIJTO4 PM �E
FOR THE L , TRl1GiI01v SH
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,_yAT1INSONPETWIO19EQUIRED MF DOIREMENTSOFTH
P,JRPD CONCRETE COM OF NEW YORK STATE.
1 4 Jl,. H - t-RAMING & PLUMBING
'L - G:NSTRUCTION MUST
_ ALL CGN: ,,%TION SHALL MEET THE CERTIFICATION OF
- t.('.QL. ' , �.•� 1'L'jd REQUIREMENT- 7FTHECODESOFNEW NAILING 6'CONNECTIO S
YORK STATE. NOT RESPONSIBLE FOR F ED.
DESIGN OR CONSTRUCTION ERRORS. O
g15Cy
OCCUPANCY OR 9
USE IS UNLAWFUL No 05250
WITHOUT CERTIFICATE 9pFesSIO
OF OCCUPANCY
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