HomeMy WebLinkAbout30115-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30778 Date: 02/18/05
THIS CERTIFIES that the building ADDITIONS/ALTERATIONS
Location of Property: 1900 WESTPHALIA RD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 114 Block 7 Lot 12 .1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 25, 2004 pursuant to which
Building Permit No. 30115-Z dated FEBRUARY 25, 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 ADDITIONS & ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to RICHARD J & CATHERINE HART
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 89304C 10/15/04
PLUMBERS CERTIFICATION DATED 12/31/04 HI-TECH PLUMBING&HEATING
tho ized Signature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802 FEB 16
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. /d-Z1/-0Y
New Construction: Old or Pre-existing Building: (check one)
Location of Property: //0 0 vtledt�jec /fc � ��
House No. Street Hamlet
Owner or Owners of Property: 6 P" z M�
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. dolls Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval: /
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: V (check one)
Fee Submitted: $
Q.�
Applicantignature
1p
6�.W41
�y�1fF%t
Town Hall,53095 Main Road % Fax(631)765-9502
P 0. Box 1179 � �aO~ Telephone(631)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: /,1- 1-0
Building Permit No.
c oilJ
Owner: eA r14
(pl print)
Plumber: _ HI-TECH PLUM°ING&HEATING ENT iU'—
(Pi", TD.
R ER � D,NY 11031
6 31-722--COI G
lead. I Certify that the solder used in the water supply system contains less dm 2/10 of 1%
(I']utubers Si
Sworn to before me this,��
day of_L ' �✓ . 20 C5�
Notary Public, �vt�County
NdW MK S d NW Yak
No.4777162
OAMW in Wk*CounQr
Gommission E>�es April 30,ZO
TO 39Vd t4I S31VIDOSSV lOtIN39 E9ZZZZL1E9 Zb:ET t?@OZ/TZ/OT
Electrical Inspection Certificate
Issue Date Electrical Inspection Service, Inc. Application Number
10/15/2004 375 Dunton Avenue 89304C
East Patchogue,New York 11772
(631)286-6642
Issued To: Mr& Mrs Hart
Street: 1900 Westphalia Road
Village: Mattituck Zip: 11952 Town: Southold
Section: Block: Lot:
Contractor: Double-Pole Electric Inc. Lic. # 3913-E
Was examined and found to be in compliance with the National Electrical Code.
❑ Commercial ❑ NV Defects ❑ Pool ❑X 1st Floor ❑ Indoor ❑ Basement ❑ Hot Tub
X❑ Residential ❑ Det.Garage ❑ Attic X❑ 2nd Floor ❑ Outdoor I Addition ❑ Survey
Switches Receptacles Fixtures GF1 Heaters A/C Fans
19 13 15 2
Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves
Furnace Oil Gas Circulators Smoke Detector Bell Transformer
2
Meter Amps Phase UG/OH Jacuzzi Television CO Detector
/ 1
Bldg. Permit. 30115
Other Equipment ��--
attic fan
Hugo S. gurdi
President
Rough Inspection: 07/01/2004
Inspector: John McMahon III
Final Inspection: 10/14/2004
Inspector: John McMahon III
This certificate must not be altered in any manner. Inspectors may be identified by their credentials.
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. 30115 Z Date FEBRUARY 25, 2004
Permission is hereby granted to:
RICHARD J HART
1900 WESTPHALIA AVE
MATTITUCK,NY 11952
for
ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at 1900 WESTPHALIA RD MATTITUCK
County Tax Map No. 473889 Section 114 Block 0007 Lot No. 012 . 001
pursuant to application dated FEBRUARY 25, 2004 and approved by the
Building Inspector to expire on AUGUST 25, 2005 .
Fee $ 454 . 80
t or' >'I' s-i-I�ure
ORIGINAL
Rev. 5/8/02
3- ow rz:�--
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ATION
[ ] FRAMING [ ' FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: ASP/�I✓�- 4N+l L
DATE / � � INSPECTOR-�"�
765-1 802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH.PLBG.
[ ] FOUNDATION 2ND [ ] IN L N
[ ] FRAMING [ FIN/KL7�//
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
v
DATE , /////7 INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROU H PLBG.
[ ] FOUNDATION 2ND [ NSULATION
[ ] FRAMING [ ] FINAL
[ ]
FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
Ak
DATE INSPECTOR
DEPT:
INSPE7OUGH
IO
[ ] FOUNDATION IST PLBG.
[ ] FDATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ]
FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: (Azz�
DATE � ( INSPECTOR
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-02485/00007 January 23 2004
FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S)
Under the Environmental January 23, 2009
Conservation Law
TYPE OF PERMIT■New ❑Renewal ❑Modification■ Permit to Construct ❑ Permit to Operate
❑ Article 15,Title 5: Protection of Waters ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27,Title 9; 6NYCRR 373:
❑ Article 15,Title 15:Water Supply ❑ Article 19:Air Pollution Control Hazardous Waste Management
❑ Article 34:Coastal Erosion
❑ Article 15,Title 15:Water Transport ❑ Article 23,Title 27: Mined Land Management
Reclamation
❑ Article 15,Title 15: Long Island Wells ❑ Article 36: Floodplain Management
❑ Article 24: Freshwater Wetlands
❑ Article 15,Title 27: Wild, Scenic and ❑ Articles 1,3, 17, 19, 27, 37;6NYCRR
Recreational Rivers ■ Article 25:Tidal Wetlands 380: Radiation Control
❑ 6NYCRR 608:Water Quality Certifica- ❑ Article 27,Title 7; 6NYCRR 360:
tion Solid Waste Management
PERMIT ISSUED TO TELEPHONE NUMBER
Richard Hart (631) 298-0009
ADDRESS OF PERMITTEE
1900 Westphalia Road, Mattituck, NY 11952
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
NAME AND ADDRESS OF PROJECT/FACILITY
Hart property, 1900 Westphalia Road, Mattituck SCTM#1000-114-7-12.1 l
COUNTY TOWN WATERCOURSE NYTM COORDINATES l
Suffolk Southold Mattituck Creek
DESCRIPTION OF AUTHORIZED ACTIVITY:
Add a 27' 9" x 36' deck to the rear of existing single family dwelling and repair roof. All work must be done
in accordance with the attached plan stamped NYSDEC approved on 1/22/04.
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all
applicable regulations, the General Conditions specified (see page 2 & 3)and any Special Conditions included as part
of this permit.
PERMIT ADMINISTRATOR: ADDRESS
Mark C. Carrara (CKW) Region 1 Headquarter Bldg. #40, SUNY, StonyBrook, NY 11790-2356
AUTHORIZED SIGNATURE DATE
Page 1 of 4
/� � January 23, 2004
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
1. Any debris or excess material from construction of this project shall be completely removed from the adjacent area
(upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or
protected buffer areas.
2. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion
or prior to permit expiration, whichever comes first. The approved methodologies are as follows:
a. Stabilization of the entire disturbed area with appropriate vegetation (grasses, etc.).
3. The storage of construction equipment and materials shall be confined to within the project work site and or upland
areas greater than 100 linear feet from the tidal wetland boundary.
4. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one (1) week shall be
contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the
seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these
approved methods.
5. Roof runoff shall be directed to drywells a minimum of 100 feet landward of the tidal wetland boundary for
immediate on-site recharge.
6. Sanitary system (bottom of tank and leaching pools) shall be located a minimum of 2' above seasonal high
groundwater.
l
DEC PERMIT NUMBER PAGE 2 of 4
1-4738-02485/00007
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15(TITLE 5), 24, 25, 34 AND 6NYCRR PART 608
(TIDAL WETLANDS)
1. If future operations by the State of New York require an alteration in the position of the structure or work herein
authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable
obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the
people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered
by the Department to remove or alterthe structural work,obstructions,or hazards caused thereby without expense
to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other
modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to
the State,and to such extent and in such time and manner as the Department of Environmental Conservation may
require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the
navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on
account of any such removal or alteration.
2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein
authorized which may be caused by or result from future operations undertaken by the State for the conservation
or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any
such damage.
3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission,
consent or approval from the U.S.Army Corps of Engineers, U.S. Coast Guard, New York State Office of General
Services or local government which may be required.
4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended
solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other
environmentally deleterious materials associated with the project.
5. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large
refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause
damage to navigable channels or to the banks of a waterway.
6. There shall be no unreasonable interference with navigation by the work herein authorized.
7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the
applicant shall,without expense to the State, and to such extent and in such time and manner as the Department
of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and
restore the site to its former condition. No claim shall be made against the State of New York on account of any
such removal or alteration.
8. If granted under 6NYCRR Part 608,the NYS Department of Environmental Conservation hereby certifies that the
subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302,
303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217)provided that all of the conditions listed herein are
met.
9. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top
portion of the enclosed notification form certifying that they are fully aware of and understand all terms and
conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be
signed and returned, along with photographs of the completed work and, if required, a survey.
10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the
applicant or his agent as part of the permit application.
Such approved plans were prepared by Catherine Hart dated 9/15/03.
DEC PERMIT NUMBER PAGE 3 OF 4
1-4738-02485/00007
DEPARTMENT OF THE ARMY
NEW YORK DISTRICT,CORPS OF ENGINEERS
JACOB K.JAVITS FEDERAL BUILDING
NEW YORK,N.Y. 10278-0090
REPLY
o
ATTUMTENTION OF September 15, 2003
Eastern Permits Section
SUBJECT: Joint Application with New York State Department of
Environmental Conservation
Richard and Catherine Hart
1900 Westphalia
Mattituck, NY 11956
Dear Mr. and Ns Hart:
We
cently
for permit vyourefiled withethe NewGYorkopy oState Joint Application
Environmental Conservation (NYSDEC) . to Department of
Please be advised we have reviewed the copy of the Joint
Application sent to this office by NYSDEC. Based solely upon the
information provided, it appears that a Department of the. Army
permit is not required for your proposal .
The Department of the Army regulates construction activities
in navigable waterways and discharges of dredged or fill material
into waters of the United States, including inland and coastal
wetlands . If your proposal would involve such work, and has 'not
been portrayed as such in your Joint Application, you should
contact this office immediately so that a project-specific
determination can be made as to whether a Department of the Army
permit will be required.
Any inquiries can be directed to this office at (212) 264-
3912, 3913, 6730, or 6731 .
Sincerely,
Marc Helman
Acting Chief, Eastern Permits Section
DEC Application No. 1-4738-02485/7
` 1 _
Albert.J.Krupski,Presidentg11FFO(�-c
O� � Town Hall
James King,Vice-President 53095 Route 25
Artie Foster o P.O.Box 1179
Ken Poliwoda Southold,New York 11971-0959
Peggy A.Dickerson Telephone(631)765-1892
�.( `�►a Fax(631)765-1366
BOARD OF.TOWN TRUSTEES
TOWN OF SOUTHOLD
August 7, 2003
Mr. & Mrs. Richard Hart
1900 Westphalia Rd.
Mattituck, NY 11952
RE: 1900 Westphalia Rd., Mattituck
SCTM#114-7-12.1
Dear Mr. & Mrs. Hart: .
The Southold Town Board of Trustees reviewed the survey prepared by Joseph A.
Ingegno dated May 5, 1999 and determined the proposed deck to be out of the Wetland
jurisdiction under Chapter 97 of the Town Wetland Code and Chapter 37 of the Town
Code.
Therefore, in accordance with the current Tidal Wetlands Code (Chapter 97) and the
Coastal Erosion Hazard Area (Chapter 37) no permit is required. Please be advised,
however, that no construction, sedimentation, or disturbance of any kind may take place
seaward of the tidal wetlaads jurisdictional boundary or seaward of the coastal erosion
hazard area 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 and
Coastal Erosion Hazard Area, which may result from your project. Such precautions
may include maintaining adequate work area between the tidal wetland jurisdictional
boundary and the coastal erosion hazard area and your.projector erecting a temporary
fence, barrier, or hay bale berm.
However, any activity within 100' of a Wetland line or seaward of the Coastal Erosion
Hazard Area would require permits 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.
- � 2
Sincerely,
Albert J. Kru ski J
p r.
President, Board of Trustees
AJK:lms
• _ _ _ TOWN OF SOLD OPERTY RECORD CARD _ 3
OWNER STREET/q(,/U- VILLAGE DISTRICT SUB. LOT
*Ca1
FORMER OWNER N E ACREAGE
S I' WSaTYPE OF BUILDING / yt
SES. p SEAS. VL. FARM COMM. I IND. I CB. I MISC.
LAND IMP. TOTAL DATE REMARKS
To 0 3 coo 3 7 - (,' 0 l � s
700
t c= �DQ�
3 o a
? � e C; b16 .?--
,5,AGE 3 o-v BUILDING CONDITI N
NEW NORMAL BELOW T` ABOVE
Farm i
Ti I lab.le 1
Tillable 2Tillable. 3 �Q�•�.-caQ ,�5�-YEN _._ - ----
Woodland \ �,
Vj E S�' —
Swampland i ,
Brusmand
House Plot
Total
t
■■■��% _,■■■■■■■■■■
Bldg.sk Foundation :.
th
Extension :. Floors
Extension 3 S- Ext. Walls Interior Finish
Fire PI Heat
Extension Z) raw
Por:h Attic
Porch Rooms lst Floor
.. ��
.3reezeway Patio Rooms 2nd Floor
Driveway
�®
ENERGY CODE CALCULATIONS CHAPTER.5 SECTION 501
Detached One and Two Family Design Criteria 5750 Degree Days
(For Non-Electric Heat) Zone 11B
For: per: P{h-) !._.,r►.4,
6tJ, ej • 4 �s
eft !i Dated: G v,
SUBSYSTEM AREA DESIGN CODE DESIGN CODE
"U" "U" UA UA
Fzterior Walls /` '0.loo 0.14
Ceiling Roof ? 4 o.830 0.031 23 . 73
Floor Over Unheated Space7 1 O p s 0.05 3 r '? P. L
Heated Slab On Grade 6.5 =
Unheated Slab On Grade 4.5
Basement Wall 0.1
Crawl Space Wall 0.06
NOTES: 2 6 ' L Z 7 . 7
Construction shall comply with 502.1.1 moisture control and 502.1.4 air leakage
Building Envelope Systems to meet requirements of Section 501
The mechanical systems and equipment including:
HVAC Equipment,HVAC Systems,Duct Systems,Ventilation Systems and Insulation of Piping Systems to meet
requirements of Section 503
Service Water Heating Systems&Equipment to meet requirements of Section 504
Electrical&Lighting Systems&Equipment to meet requirements of Section 505 t of NEW
g�P �CE
v
To the best of my knowledge, r r
belief, &professional judgement, , om ,
these plans are in compliance ���FE8S10%
with;the code. ��
LAWRENCE M. TUTHILL
PROFESSIONAL ENGINEER
P.O. BOX 162
GREENPORT, N.Y. 1,1944
(631)477-1652
I,I 4 2004
September 10, 2004
Mr. Michael Verity, Department Head
Southold Town Building Dept.
Main Road
Southold,New York
RE: Hart Residence
Westphalia Drive
Mattituck,New York
Southold Town Building Permit# 30115
To Whom It May Concern:
This letter is to certify that all wind load strapping has been installed during the
construction of the addition to the house. I verify that all work has been done in
accordance with New York State Building Code and the Southold Town Building Code.
Sincerely,
Lawrence M. Tuthill, P.E.
�pF N�iyr
032264-1
�r
jpppp-
A h
FIt;I.D INSPECTION REPORT DATE COMMENTS ! cam'
z61 'e-
FOUNDATION(1ST) t oo
-------------------------------
FOUNDATION(2ND)
� o
i�
r ,►ZI
ROUGH FRAMING&
PLUMBING �^
r�
r
�n
INSULATION PER N.Y. y
STATE ENERGY CODE
71
C
FINAL
ADDITIONAL COMMENTS
N
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m
X
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H
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DtPARTMENT Do you have or need the following,before applying?
TOWN HALL
SOUTHOLD, NY 11971 Board of Health
TEL: (631) 765-1802 3 sets of Building Plans
FAX: (631) 765-9502 Planning Board approval
www. northfork.net/Southold/ PERMIT NO. 3oogz- Surveycheck
Septic Form
N.Y.S.D.E.C.
Examined Zj 120-1Contact:Trustees
Approved -2I ZT' 20__� Mail to: 00(/U ��'
Disapproved a/c `� , 1
Phone:_ %51
Expiration ¢' 20..
Building lnsp or !
FEB Z 5 X04
G APPLICATION FOR BUI DING PERMIT
' .
Bate 206_
INSTRUCTIONS
a. This application.MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
s s 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 cornmenced 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 MADL 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. /�."
(Signatur of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
6 l tl NeA--
Name of owner of premises /Cc" I � IC 'ter 6
(Aso the tax roll or late" deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. o?O -0)C) /41
Plumbers License No. J0 eo m
Electricians License No. 3/►1 e
Other Trade's License No.
1. Location of land on whit proposed work will be done:
1 ,9z)6 wee dx o- /&-e- A77-14clic
House Number I Street Hamlet
County Tax Map No. 1000 Section ( � Block Lot p�
Subdivision Filed),Map No. Lot
(Name)
2. State existing use and occupancy of pre ises and intended use and occupancy of proposed construction: k
a. Existing use and occupancy uxl—c. A,,V, OC a,WA)rV C;
b. Intended use and occupancy P(1 f V,oj e .� 0 C
3. Nature of work(check which applicable): New Building Addition ✓
Repair ,/ Removal Alteration
Demolition Other Work
4. Estimated Cost 90I as d (Description)
— Fe ISv
5. If dwelling, number of dwellingunits (To be paid on filing this application)
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. NA
7. Dimensions of existingstructures, if any: Front R� Rear 01l/f ?11
Height 161 �r. Depth ��16
. Number.if Stories
t oN r �##
Dimensions of same structure with alterations Vr additions: Front q%' 4
Depth n Height •ZJ:5Number of Rear 9
Stories 2.
8. Dimensions of entire new construction: Front_ o)b Rear l� Depth
Height e�U /S Number of Stories_
9. Size of lot: Front _Rear 1,91.6 Depth 98.0 6
10. Date of Purchase ('21 9 Name of Former Owner /j,
j,C"fo'cUK 4essAr-
�x
11. Zone or use district in which premises are situated 3 6e61 ,'AJ,-,
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO ✓
13. Will lot be re-graded? YES NO ✓Will excess fill be removed frorn premises? YES NO
14. Names of Owner o5520t
Address / ao W1'' / '� o? 9 -000 9
Name of Architectone No.
Address i►7 Phone No -4---17-- Q
Name of Contracto _ Address a x Phone No. Z -
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)
COUNTY O h K,SS:)
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 perfonned 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
da
y of �......_ 20
_a4 C
otary Public Signature of tk plicant
LYNDA M. BOHN
NOTARY PUBLIC,State of New York
No.01 806020932
Oualified in Suffolk County
Term Expires March 8,20 a
BUILDING PERMIT EXAMINER CHECKLIST
DATE REVIEWED: 07 05/04
APPLICANT:"(" DATE SUBMITTED:c::2_�( /04
SCTM# DISTRICT: 1,000, SECTION: (14- , BLOCK: �� , LOT: \2•k SUBDIVISION: -—
ADDRESS: IqCo _CITY: (Y1c� '-{yc ZONING DISTRICT: CONFORMING?
BUILDING PERMITS OPEN/EXPIRED: PRE COI�f)JR N�_!QgQ 7$
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:
LATS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83
REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. �s°�. ACT. LOT COV.
REQ. FRONT 5) PROP. FRONT_ /REQ SIDE (t436- ACT. SIDE
REQ. REAR 5a I PROP. REAR ✓ REQ. HEIGHT PROP. HEIGHT
PROJECT DESCRIPTION: b
ESTIMATED PROJECT COST: ARCHITECT ��'i--�
WATERFRONT? DESCRIPTION: 5;L PANEL # FLOOD ZONE: )C _
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DEPT: YES or 0, (BED #): DTE: / / PERMIT#:
TOWN SEPTIC RECEIPT: Y ore) /-y7 33k_ores
NEW YORK STATE DEC: PRE-DEC 9/1/75E or NO DTE: 1 /03/ y PERMIT #: ao oo- _
SOUTHOLD TOWN TRUSTEES: ES r NO DTE: /Z/ PERMIT#_
TOWN ZONING BOARD APPROVAL: YES o DTE: / %' PERMIT#:
TOWN PLAN. BOARD APPROVAL: YES or DTE /_�_/ PERMIT#:
TOWN HISTORICAL PRE (SPLIA): YES o O
NEW YORK STATE CODE COMPLIANCE (SEE PAG . E r NO
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: 5Z SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
Q' TOTAL: _SF FEE FEE FEE
1. 0( 1 �6 SF)- ( 6670 10 ((,
�J �o
SF)= (U (� SFX $ 9 0 _` -$ +$ �S� � +$ _$ PI'S Y �
2. ( SF)- ( SF)= SFX $ =$ +$ +$ _$
3. ( SF)- ( SF)= SF X $ =$ +$ +$ _ $
FINAL TOTAL: $
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: Q,3
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION:
DESIGN CRITERIA: ENGINEERED SCRI T U_Vr-C?A,
FULL FRAMING DESIGN ELEMENTS: Y/N
HEADERS: Y/N WALL STUDS: Y/N GIRDERS: Y/N
CEILING JOISTS: Y/N FLOOR JOISTS: Y/ ROOF RAFTERS: Y/N
LUMBER SPECIES AND GRADE: Y/N
DESIGN LOAD CALCULATIONS: Y/N
LIVE: Y/N DE+D Y/N SNOW: Y/N SEI IC: Y/N WIND: Y/N
WINDOW AN14-DOOR SCHEDULE:
MISSL9,TE8T REQUIREMEN : Y/N l
EGRESS 5.7 S.F.: Y/N
LIGHT 8%: Y/N
VENT 4%: Y/N
NAILING/CONSTRUCTION SCHEDU : Y/N
MEANS OF EGRESS: Y/N
PLUMBING RISER DIAGRAM: Y
LOCATION OF FIRE PROTEC EQUIPMENT: Y/N
TRUSS DESIGN: Y/N
CERTIFICATION: Y/N
ENERGY CALCS:
TOTAL COMPLIENC /N (RETURN TO PAGE ONE)
1,
t t �
SURVEY OF PROPERTY
SI T UA TED A T
MATTITUCK
TOWN OF SOUTHOLD
S. C. TAX No. 1000- 1 14-0'7 -- 12 . 1
.0
SCALE 1 "=30' �F
MAY 5, 1999A�i ` SS0.
S d
AREA = 73,938.83 sq. ft. pow \ ��3•.
(
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CER TIFIED TO:
FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK
• i' °�� .,o - ii GE CAPITAL MORTGAGE SERVICES, INCORPORATED
• ��• w h"' RICHARD J.
A
-(b .. CATHERINE V HART
/ 9'L•
•• 4
. PREPARED IN ACCORDANCE WITH THE MINIMUM
STANDARDS FOR TITLE SURVEYS AS ESTABLISHED
BY THE L.I.A.L.S. AND APPROVED AND ADOPTED
FOR SUCH USE BY T NEW YORK STATE LAND
v TITLE
/ 0$,AND
��5�QN a
IN h'
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•9 •496
FOF N
N.Y.S. Lic. No. 49E61
.90
17
r, `�� x P
YV��(� •, fe • �rCk<h UNATHORIZED ALTERATION (OR ADDITION A� A.
'n e gn o
\j '' ��✓Ce TO THIS SURVEY IS A VIOLATION OF F+
pp� • N 70•G EDUCATIONLAW
SECTION 7209 OF THE NEW YORK STATE O V
A
� 4
• • . ' / T .p� M�• GG ly COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor
T• ,• �/1 • THE LAND SURVEYOR'S INKED SEAL OR
• 28 EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VAUD TRUE COPY.
CONCO CERTIFICATIONS INDICATED HEREON SHALL RUN
• ��� �'�• •• YY s'' 'NaN. ONLY TO THE PERSON FOR WHOM THE SURVEY Titre Surveys — Subdivisions — Site Plans — Construction Layout IS PREPARED, AND ON HIS BEHALF TO THE y
r TITLE COMPANY, GOVERNMIENTAL AGENCY AND
i :: •
,..• . TLENGO DD N I STATUES NOFLD H
ISTTHEE 1EN01NG'irAisTl- PHONE (516)727-2090 Fax (516)722-5093
.• TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. MAILING ADDRESS
;I OMCES LOCATED AT
' THE EXISTENCE OF RIGHTS OF WAY One Union Square P.O. Box 1931
AND/OR EASEMENTS OF RECORD, IF Aquebogue, New York 11.931 Riverhead, New York 11 S
I I ANY, NOT SHOWN ARF NOT GUARANTEE[:.
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PLUMBING
NEW _ - ALL PLUMBING WASTE
- 13 ING _ - - - - - EiUSTI 6 d WATER LINES NEED I "
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NOTIFY BUILDEPARTMENT
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FOUNDATION TWO REQUIRED
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BE COMPLETE FOR C.O.
: - ALL CONSTRUCTION SHALL MEET THE -
REQUIREMENTS OFTHECODESOFNEW
` "YORK STATE. NOT RESPONSIBLE FOR
FROM , � ',� - DESIGN OR CONSTRUCTION ERRORS.
" , '• G7 �
SCgLF Ya' = Tm" PLUMBERCERTIFTCAmy
ON LEAD CONTENT BEFORE T
CERTIFICATEOFOCCUPANCY Z'
SOLDER USED IA/WATER � I,
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3Nt t72 12
EXCEED 2/10 OF t%LEAD. '
RETAIN STORM WATER RUNOFF ,
PURSUANT TO SECTION 45dOC
,
OF THE TOWN CODE.
UN6FP'diTERSCERTIFICATE'
BECUIRED CERTIFICATION OF
NAILING & CONNECTIONS
_ REQUIRED.
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THE F NEW yoW F "
- CODES OF NEW Y
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an.drhe'toiconslruongndownterttak'farNsgbaNgdnipn 1 ANyieda'Pdentl2x6, - nBinaleYhf ..- . ' ' •,-- �,� '-'_
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aP b�glNp undw all b"O"wage IIII!
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7.coatand'WmdbW treader to align Uldelredtrrtvlae nMed, - - _ _ ,�,.� 511112 I ,
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ON"$,PM*ck ,Md Prneftftt SO required by approved conshucWn -
6.Cieneri carrfraciorto coneMtand coonfinals doth the ornsr and the,plahe for alk prdbea; - - P�'FL,3�R Gi '10 Wt6�7 �...•. _4�6 _ ` .,
buxtin aims Tuan as hoaiioanas,
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to.Pfo'vidb hardwired snlofte detectors,WIM batterybad o*,an oil Soar antl in each _ � _ - -- m -
'badmdm;vvMh boat cope 1agWraNrldmr saw 66atlon gal?,New Yas t')IaM 11.Provafaap'propiiate ardftt vemNNon N overhangs,
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Wwft FOVNDATIQN-NOTES 1.Pourrdiirrp wbcontnctar M W responsible Mr atlhsrina to ao applicable code and
ralMY rrgrritrmM N, IOBLI IE i0@ AM1AU �2.1BA PFR h�OT A ^--_T__ F
. 1 i9eherl eonhador to review plane,alevatiom,and det ills'tb
FMiphh af,5alahed Iloef(e)ahbw tYP I9rdtle. 2. If WQU Plants or)ololaam cutde�e the inehl$don of ptumbirq�'tbrmms or -
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2 AvtdodnpatoNlN on'undislrabetl sol gquipinwd proNdrrinechrp totib hamfirp•beck togaNer.. - - -' E'Aq¢r8'AIe1Ai 'li^c,54FPtlR7&'INTtE }[� �`
HVAC SYSTEM NOTES I ed .PANELFEIiI'
3 Pnuvlgr 36Fesy¢ ifM,rhahrNl batY}r•ut#Ilcglu:retq'WYbll arM abuttlhg, - -- aB'GYC.$'-MT'PM' L-€p(3E8Si3-D
oondAppa,m rh may 9gbomnII in l llribt'ofUnlxaifetl hrpeapr/Nps. I' I40 hmrd0 }aefaoftcWr is igpowllte Mr adhering to AN.OPPOmble codes and I_ 8d APl r i •dAIE¢4pP4Ri$'pLhER/dEL Plan
.. .4 ato))*�la courts Hui sWWblWrhmrmaa y"Wianew tihtrl10 i: !ai! !mf 2 gp mraabrto h;nr coordin to aasywma+la and hr4uirememalapn nre 19ooE�}JtE'I ,D^QF .4. `r e -
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_ -�-T-a n .AN'ffS7tr1EM9 SFIALL�E USED. _ 7t€. 2
'� ' - 6;ProvMe oraow'sjlpeawaWgfcn Psrbcataode ragdrihbltm. equipment tlupp5er:
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3. ursaw, mmmor,aofoYtdPRWlda supol ar or hyaut drawinp,wd,oviW perrerW _ -Sof'. 19 -
' 6.OMgrl aontradbrlviaiRsll pafrM1bfC far95pParode pirtlinagohi*sWaii. amiaaaktr',aweer,artdlgAdVitantaupplMr?or rynai,ravhWand'appraval. -
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Adlt(alaa 6om SWW*d for HINFIaarwIFINt Mont RaAidMW CorgWWong SSTD 1"9 - I
and:4905 SBC FgyFi'Wind Edition Wood Frame CogeWblMn A tNfEM�Dt4'IY SIAPQRB W7FE PAtEL FIEID .
�Pt ceQR PIAN NOTCS Pashimmi s and Conrwk ma for Wood Prams Ognsirudt on
1 DlmrmeWns ehNltake prpa iant War aeale damelinps.(do neleosledrewinya), 1.A cogtlnums bad path pshypeh botlngs.Imlidadons,waer,Doors,swft and roof ..�__.._.., ��`F-_A 5d 000111�R8 7'�1 011 7 'tD
TABLE 3.7
2AahasaprwYNsfa,heaomad'wlliftW bondvddrmeedoofiwrmlNemina, lrsminp.lha5baprovMstl: �T1 GE'3,A - r _ _ ---- -----
Talpe,part nM Nrrd'(3'0306). - - 2 Approved eanneccWraa enchors.and otlrsrtaNenihp devbes not inducted In the S�-N [NORO ONW000 SBC HIttH 1M •EDI7a7N WDOD F E 1`_.__
4.4
SLnctero Bpddirrp Cade 'F"abfa 2adB.1'ahali 4eerrr5ad In oaCardone*vwtll FRAME'CONSTRtICTIDN�iIAMIAL� CWTRUCTION MANUAL (fir
S Vsdle agrrrgarrte.parepe rlldtharaete bwa a farergf.6ib",1N�-retail WiNam'bo.W aunullet;W r'e NobnosteldoM. 'INS 'tbv"tMD
.,gtpuapn sftlY:vdftrb'•IPrytaA mi rdJitlr}if 1ta1p and a6YNy. FnIallaibNarad'1tanDM' . : : - 12 ml�r FA4'76S Di3`�E D. '- .ZC
ragsG'n gJ.y«r of tint^,Ne nand pypWm troaro 3.MAIN pi*0 connector,sprees,both,enq'neih exposed directly to the aaa her or - N-'-----"- R PITCH AN -
e All"and bilatw"*ahpM beilinps 0d)amxaM'igatarea'to•haw asYr ayb)ptl to''aaearoslon in c3rW arMs,ehNl be spbleas steel or not dipped ROOF N R t
Wevanl3ed,
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naiaerra-DyparanitdsN
or WOO ills Won wonderboaro of egoN. }hra.. l%" dr=*
do" rt 12 -__? 6 r2 a 7 1191
rrfl n/dara elle!!ba ProrrMrd attlte tOpal sheafhinp rhe acting, -^ a 7. 2
S�rlli 4. rte wintlass and _
- s*d at cal pa_ and bottom of cripple -
atheslorroeWdaJ
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E)MISMg gin - d.a ot'tx6 orl?"karaiertr Nosid in,UOW tNrdofr*illimpe,and witch to eaohpairOf ---�
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A : - fi.,tIp5lCaenns3tor ehtdl lie-provided Neaoh'raftphrgdng. _
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t Mrdrl6'AW e>Iped np A:fMauu an eta. -
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