Loading...
HomeMy WebLinkAbout30346-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30587 Date: 11/23/04 THIS CERTIFIES that the building ADDITION Location of Property: 3215 DEEP HOLE DR MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 115 Block 16 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 2, 2004 pursuant to which Building Permit No. 30346-Z dated JUNE 4, 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. The certificate is issued to SCOTT & KIM MARIE CZUJKO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A C ho ized 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. 30346 Z Date JUNE 4 , 2004 Permission is hereby granted to: SCOTT & KIM MARIE CZUJKO 3215 DEEP HOLE DRIVE MATTITUCK,NY 11952 for CONSTRUCTION OF A DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 3215 DEEP HOLE DR MATTITUCK County Tax Map No. 473889 Section 115 Block 0016 Lot No. 016 pursuant to application dated JUNE 2 , 2004 and approved by the Building Inspector to expire on DECEMBER 2005 . r Fee $ 150 . 00 e Signature ORIGINAL Rev. 5/8/02 P1 Form No.6 IN9 TOWN OF SOUTHOLD / BUILDING DEPARTMENT TOWN HALL 765-1802 2 APPLICATION FOR CERTIFICATE OF OCCUPANCY 3 � 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. i I i 23 )0-y New Construction: Old or Pre-existing Building: `� (check one) Location of Property: 3.21 S Dr I vt MA-a 1'f V C lL House No. Street Hamlet Owner or Owners of Property: C_.Tr- 2V.TK-o Suffolk County Tax Map No 1000, Section // S Block 001(- Lot 61(o Subdivision Filed Map. Lot: Permit No. 3 U Date of Permit. G) I) o y Applicant: � z ii C1„�rim Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ `Zs, cu Applicaniignaae ,•'.. T.F •F'ti{`a yr 30,`�T` � a�rf~ � ',�� 'i.• •?q 'r' ,,,,;:i'-.,..'+,amu....�... • .. . . .... -• y }x L of 5,6 ` p Areo rf�, ?►z } J. 0 f,f 44 40 0 ti: t�ya: •,�;�. .� \��� spm ..� „� �,.: iti://�� Sw� •tel A' � 0' � b• ` _•�• i \ f - 1+� .. ir� Y,+ l■l■l■'^^^^ ��rrrlll7'�'/� � • \ l � E�� ��IV' .. ,� _ .. V { �..:L\,�'1, rr� r +i ce �� .. • t' kx ^ow is 46 40% K s`r NOTE fy. :. E1M � r pFN �M,QQ��GWEW. NT ���� r 1B MS%ON'MAP ° Of THE CLERK OF SUFFOLK COUNTY ON ._ ✓AN. .Z9,196d AS MAP NQ 4f36. OCA[TION OF WELLS AND CESSPOOLS ��s �'a• 12 a ab oo° t SXOWN HEREIN AIRF FROM FIELD OBSERVA77098 .00 •� .. RIND/OR FROM D$TR OBTAINED FROM OTXERS ��M�t ENIitNEEp RBVISIONS YOUNG & YOUNG MAX 4 1975 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK MAR/2,1975 APR.29,1975 ALDEN W. YOUNG HOWARD W.YOU G.- PROF'ESSIONAL ENGINEER AND LAND.Sujmv9TQMrtF;;;. LAND SURVEYOR. N.Y.S. LIC. NO, 12645 .•,.N.Y:SL'L`IC. N0.455si ALrCMATM 011 AoaTH1N m SURVEY FOR:. WI�'�M A'MOLN40.of o"TION BEN MEND 0 Z Z A Ta TORR ['[OUCAT10N W ' LOT 58 II DEEP HOLE CREEK. ESTATES" W494 OF-T"SURVLr YAP NOT.SWUNo AIM V01111I INII[q UAL OR ' 'IKAL SNALL NOT u CONNDLRLo 1M410 Twx COPY . AT t • MA T T I TU C K GUARANTERD TOs NRA1A[LI NNNCAT[D NLRLON SHALL RUN �WTEER ArA.EzwlsGWQF AA/E7PII~4NT/TLE/K4 RY MTN[F[RION FOR WHOM TNL TOWN OF 0 T H O L D RTW'h L1 CQ IA. AND ON NIS uTALiR. . ITII�XD�iOVIA�i� � � TM[T{ri[CONIMNr,SovLRNYEMTAL ' I[M N AXW O MDIMI 10STITUTHM LISTED SY XMi'00 TO TNL AISIONLLI OF THE SUFFOLK CO., N.Y. .Rye^ es i/TYTION. IUARANTLLS AMC .. NEON A RIBIII MENEM EM:::.Mi111R1ME0•• TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT Sip MrA�in"en ,. le 'r- 10-1 ,� c.,< <. Lee ��'. ° FORMER owwk N E AC%/ S W TYPE OF BUILDING 1A10. a ES�Jo SEAS. VL FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS 714 Q Q �YO np / y SoL-n 41r9 56o. 6LSo Lois S -.S" G C.ZRLEsK/ /�'IEapoz2/4 700 ?ad /3 7 //49/7, to . p' �7ob iL wEw #ouSE)Z& 0 v D A v D Of S /3 ' Sol,D (f:Am/14 20, ,MeAfDoZ z A 7e, Z o. 16 - -100 019406 71c9 7S SaID '�39 J^Oo, f/Pos 't om INC, 74 N, C t - • + WE P ,2e BUIL G COY// # v / 1 E Y/ �o, --�C� C' ,1 NEW 1 V/4z7t 7� l)w., 1-FC, ? Ne FARM Acre Value Per / V lue Acre (7 1 kD 'illable 1 illable 2 s illable 3 /oodland ovamplend FRONTAGE ON WATER rushland FRONTAGE ON ROAD ouse Plot DEPTH. BULKHEAD 3tai �.. DOCK NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC DESIGN CRITERIA: Ground Snow Load: 45 Wind Speed: 120MPH Seismic Design Category:B Weathering: Severe Frost Depth:36" Termite: M-H Decay:S-M Design Temp: 11 Ice Shield Underlay:YES Flood Hazards: USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE FULL FRAMING DESIGN ELEMENTS: Y/N HEADERS:Y/N WALL STUDS:Y/N GIRDERS: Y/N CEILING JOISTS:Y/N FLOOR JOISTS:Y/N ROOF RAFTERS:Y/N LUMBAR SPECIES AND GRADE:Y/N DESIGN LOAD CALCULATIONS: Y/N LIVE: Y/N D�xJ'A-Y/N SNOW:Y/N SEISMIC: Y/N WIND: Y/N WINDOW ANd OQR SCHEDULE: Mwiwss 'kffl. "`I'REQUIREMENTS: Y/N l E 5.7 S.F.: Y/N I ,/ J TSI JHT 8%: Y/N / VENT 4%: Y/N { { NAILING/CONSTRUCTION SCHEDULE: Y/N MEANS OF EGRESS: Y/N PLUMBING RISER DIAGRAM: Y/N LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N TRUSS DESIGN: YIN CERTIFICATION: Y/N ENERGY CALCS: YIN TOTAL COMPLIENCE? Y/N(RETURN TO PAGE ONE) Ln t Au ate.•. t au I.a�a.. -�i L i v� APPLICANT: CiKp, DATE SUBMITTED: C /---fff----/04 SCTM# DISTRICT: 1,000, SECTION: BLOCK: _L( -, LOT: _SUBDIVISION: ADDRESS:3 d CITY ZONING DISTRICT: CONFORMING?&,) BUILDING PERMITS OPEN/EXPIRED: PRE CO- Y OR N BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO BP -Z/C/0 Z- ,INFO /BP -Z/C/0 Z- , INFO SINGLE &SEPARATE CERTIFICATION-REQUIRED NOTES. LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDER S D LOISjFROM JAN-1997 100-25.Merger.(A nonconforming at .y time REQ. LOT SIZE: ACT. LOT SIZE REQ.LO ACT. LOT COV. REQ. FRONT o PROP.FRONT REQS ACT. SIDE REQ. REAR PROP. REAR RHEIGHT PROP. IGHT PROJECT DESCRIPTION. A L_, ESTIMATED PROJECT ST: CHITE /ENGINEER: -fi WATER FRONT? DESCkIl'TION: --- PANEL # FLOOD ZOTfV\ APPROVALS REQUIRED SUFFOLK COUNTY HEALT YES �ED ft DTE: / / PERMIT#: TOWN SEPTIC RECEIPT:=T ——— NEW YORK STATE DEC: DEC grim YES N DTE: PERMIT#: SOUTHOLD TOWN TRUSTEES: YES or DTE__/_/_ PERMIT#: TOWN ZONING BOiYAPP.ROVAL: YES DTE: /_!_ PEF- IIT#: TOWN PLS"1. BOARD✓APPROVAL: YES DTE__/_/_ fERMIT#: TOWN HI!STORICALlPRE (SPLIA): YES NEW YORK STATE CODE COMPLIANCE (SEE GE 2)..i�E r NO NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: _SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 1. (__SF)- _SF)= SFX$ _$ +$ +$ _$ 2. SF)- SF)= SFX$ _$ +$ +$ _$ 3. (—SF)- —SF)= SFX$ _$ +$ +$ - FINAL T TAL: S 15a 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLB [ ] FOUNDATION 2ND [ ] INS ION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE � INSPECTOR 3o3�Co 765.1802 BUILDING DEPT. INSPECTION [ J FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 9l$y�pT10N [ ] FRAMING FINAL [ ] FIREPLACE 8 CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE / �� �� INSPECTORS I�aF FIELD INSPECTION REPORT DATE COMMENTS b FOUNDATION(IST) l� 3 -------------------------------- FOUNDATION(2ND) z � o V,i, � ROUGH FRAMING& PLUMBING y INSULATION PER N.Y. y STATE ENERGY CODE jj FINAL C� ADDITIONAL COMMENTS 0 C � o z M b y TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOL9 NY 11971 3 sets of Building Plans ' TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. ��3 Check Septic Form N.Y.S.D.E.C. Trustees Examined b ,20 Contact: Approved ,20 Mail to: Disapproved a/c r Phone: Expiration '20 ing Inspector J'ul,t �' 'Al LkAT FOR BUILDING PERMIT Date Col ` , 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 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 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 co d regulations,and to admit authorized inspectors on premises and in building for necessary inspections. ( 1gnature o applicant or e, ' a corporation) �.2LS 4e��darDrur�- f�fYi1/CIG N�f tIQSZ (Mailing address of applicant) State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises Sc oTT CZvwA - c,,­w (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: 3.1K5 _ 64-Nt- _ . .w rim TM"c House Number Street Hamlet County Tax Map No. 1000 Section 115- Block 14 Lot /6 ; Subdivision `D"#Jot*_F,skw_Aes Filed Map No. Lot (Name) J 2. State existing use and occupancy of premises and intended use and occupancy of proposed constrsction: a. Existing use and occupancy 'b-cc K- b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work ` -e eiL (Description) 4. Estimated Cost 1"1.61N 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 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 'ZDV Rear '78 Depth 24 r Height Number of Stories I Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Lac# q9 Name of Form?r Owner 'n iV- CAe-� 11. Zone or use district in which premises are situated R s 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO f"Z- 13. Will lot be re-graded? YES NO )C Will excess fill be removed from premises?YES NO ?e 14. Names of Owner of premises 5&.t +4^ Czvxa Address 32ts kallske br Phone No. 2AT-11206 Name of Architect Address Phone No Name of Contractor Address Phone No. 15 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 MAY BE REQUIRED. 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 OF !s�,j+ Gysw 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.) 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 a-"- day of /1200 s Notary Public SigMtufe4f Applicant LYNDA M. BOHN NOTARY PUBLIC,State of New York No.01 B06020932 Qualified in Suffolk Coun Tern,Expires March 8,20 'J �b -- ! COMPLY WIT A L CODES OF >I - APPR VED AS NOTED NEW YORK STAIE TOWN CODES 4 AS REQ' IRED A D ONDITIONS OF i J DATE. 6 B.P. #&3 SOL THOLP TOWN ZBA I FEE: i • I, /5 _ � - �/� I SO HOL�TOWN PLANNING BOARD NOTIFY BUILC �; 'r-TMEOFL GIS, i 765-1802 8 AM SO H TOWN TRUSTEES C-�"Fo'*T �1-t 0-4G, � { FOLLOWING INSPECT I�?'� G N.Y s 1. FOUNDATION - 7WO REQUIRED CtA lb t1?cu - J FOR POURED "- 1(> ETE ' �.- tod O i�t►aGu W --- I 2. ROUGH - FRAMiN3 & PLUMBING tom} ��v� Y.s 3. INSULATION OCCUPANCYOR . 4. FINAL - CON TRUCTION MUST BE COMPLETE -OR C.O. USE IS UNLAWF L' f ALL CONSTRUCTION SHALL MEET THE TI i ATE � ��� � � � ~- � � • REQUIREMENTS OF THE CODES OF NEW WITHOUT CER t { YORK STATE. NOT RESPONSIBLE FOR OF OCCUPANChh ° I DESIGN OR CONSTRUCTION ERRORS. { T I V i2�� -17 I ALL CONSTRUCTION SHALL --- CE44L 0"40 S A49T T E'.REQUIREME — NTS OF THE I� ►- �►. _�:; a w v �. W o z sk- � + 00" Cade WI R©L •� - F7 4-T. `4 � 2� ro a 1 � d � ` � _... 40 CIO T P Lr L* r-4 I = o