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HomeMy WebLinkAbout30165-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30884 Date: 04/27/05 THIS CERTIFIES that the building INGROUND SWIMMING POOL Location of Property: 4725 ORCHARD ST ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 27 Block 2 Lot 2.6 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 17, 2004 pursuant to which Building Permit No. 30165-Z dated MARCH 17, 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 ACCESSORY INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to JAMES F HAAG, JR. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 90517C 08/10/04 PLUMBERS CERTIFICATION DATED N/A ""'-L I - - ut ri d Si9fiature Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 JAN — 6 - APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be tilled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: L 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. q. Sworn statement from plumber certifying that the solder used in system contains less than 2;10 of 1% lead. 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 $25.001 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 -l. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. _ /.?'311644 SWtMKt�1G New Construction: Poo t Old or Pre-existing Building: (check one) Location of Property: 4725' 001r-t%arA Zliyc&tr a✓ic'k t�NY fI55 House No. Street Hamlet Owner or Owners of Property: J AME S P . K Pr A G Suffolk County Tax Map No 1000, Section '1't 388'5 Block .27 . — 2 — ;2 . (. Lot Subdivision Filed Map. _Lot: Jgr�cS Pen nit No. Date of Permit. Applicant: ToRToAEL, sA F&6L41 c-(o R^AG Health Dept. Approval: Underwriters Approval: v.. d► ins�ctor J1_ 661 _ Planning Board Approval: / Request for: Temporary Certificate Final Certificate: s/ (check one) Fee Submitted: $ .2 plicant Signature � '� IPfS�S7 Ca�3as �V Electrical Inspection Certificate Issue Date Electrical Inspection Service, Inc. Application 8/10/2004 375 Dunton Avenue 90517C East Patchogue, New York 11772 (631)286.6642 Issued To: Mr. Haag Street: 4725 Orchard Street Village: Orient Zip: 11957 Town: Southold Section: Block: Lot: Contractor: Ridge Electric Lic. # 1895 Was examined and found to be in compliance with the National Electrical Code. ❑ Commercial ❑ NV Defects ❑x Pool ❑ 1st Floor ❑ Indoor ❑ Basement ❑ Hot Tub x❑ Residential ❑ Det. Garage ❑ Attic ❑ 2nd Floor ❑ Outdoor ❑ Addition ❑ Survey Switches Receptacles Fixtures GF/ Heaters A/C Fans 1 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Furnace Oil Gas Circulators Smoke Detector Bell Transformer Meter Amps Phase UG/OH Jacuzzi Television CO Detector Bldg. Permit: Other Equipment pool light W---240" 1 20/220V special outlet 1 30/220V aqua link weather tight panel Hugo S. gurdi President Rough Inspection: 07/29/2004 Inspector: John McMahon III Final Inspection: 08/05/2004 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. 30165 Z Date MARCH 17 , 2004 Permission is hereby granted to: JAMES F JR HAAG PO BOX 28 ORIENT,NY 11957 for CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR WITH FLOOD PERMIT at premises located at 4725 ORCHARD ST ORIENT County Tax Map No. 473889 Section 027 Block 0002 Lot No. 002 . 006 pursuant to application dated MARCH 17 , 2004 and approved by the Building Inspector to expire on SEPTEMBER 17, 2005 . Fee $ 250 . 00 Auth raze Signature ORIGINAL Rev. 5/8/02 765.1802 BUILDING DEPT. INSPECTION ( ] FOUNDATION 1 ST [ ] ROU H PLBG. [ ] FOUNDATION 2ND [ ] SULA [ ] FRAMING [ FIN [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE -1 / - INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION , " REMARKS: az� 6"- I-A-7-u-1 5-� DATE ��` �� U INSPECTOR . rWI'H T. TERRYP0 11"N"N I lea 'r �J ,, N r G y.r;� u� `- Fay 1 i I(+; 26C.IF`l ntc;lsrr;r.r+ or .n.v sr:.nil, y n+;.nnlrcrorrl;a:n 1 _lcRln,;,c rtilrn 765. 1 nFronus M,�rvnrentE rri ornctl; FREEDCM C%r InrufU.v.nJN +:Fru.En -r ¢T FFICE OF THE TO',VN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" ( FDFI(nt ( ( , .,ncf "t-ertlficite of Compliance t•,r Development in Spacial Fla,d Hazard Ares (k- IC(93) TOV'''N OF SOIP±OLD 1 a r Judith T . Terry Southold Town Clerk.. August 25 1993 �PPLICATIOrl s PV( F Into TOYM OF 110M HOLD FLOODPLAIN DEV-L.LOPMENT PLILhII`L APPLICATION This form is to be Filled out in duplicate. SE('PION I: GENERAL, PROV1SlONI)LLkPPLICe-NT to read anti sisnl: __— L. No work may start until a permit i; issued. 2 The permit may be revoked if any fake statements are made herein_ 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be rued or occupied until a Certificate of Compliance is Lssucd. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. B. I,THE APPLICANT, CERTIFY THAT ALL STA MENTS HEREIN AND W ATTACHMENTS TO THIS APPLICATION ARE,TO THE BEST O 1 lulOWL.EDGE, TRUE AND ACCURATE. (APPLICANTS SIGNATURE)_ C- DATE Z 2 .SECTION 2: PROPOSED DFVELOPME_Tobi completed by A TLICP.t�T1 NAME —_ A-DDRESS TELEPHONE APPuc:�rrt/ � C ? BUILDER S' � d e -3 - EP7 G-ItfEER. PROJECT LOCATION: To avoid delay in proccssimg the application, please prosidc coouA information to asdy identify the project location- Provide the street address, lot number or Legal description (attach) and, outside urban areas, the distan--c to ti,c neared intersr_cting road or :.ell-Inoue tao't.mark_ A skr_tch anached io this application showing the projcra location would be helpful. FDP(93) • APPLICATIOI ; par-,E ' -lf + DFS RIPTION OF WORK (Check all apphcabk boycs) .A STRUCTURAL DEVELOPMENT ACFIVTT'r' SSTRUCTURE T"'t'PE 19/New Structure e Residential (1-4 Famdy) U Addition U Residential (More than 4 Family) U Alteration U Non-residenual (FloodprooCmg? U Yes) U Relocation U Combined Use (Residential & Commercial) Cl DcmoGtiou v Cl Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? U Ya) ESTIhLATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: U Fill U Mining O Drilling 11 Grading U Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) , U Drainage Improvements (Including Culvert Work) U Road, Street or Bridge Construction O Subdivision (New or E.zpamioo) U In(tOtter dual ase Sr c Scan Sptcm il� ❑ Other (Please Specify) 1) IM ✓h 1 jr F.Itcr wmplc(iap. SF('TIOPI 1, APPLIC';+.NT sh,uLl suhmit loan to I :,�1 :administrator Ir r rcwrw. SECTION J- FLOODPLAIN DEIERI I[NATION CTo be completed by LOCAL ADMINISTRATOR.) The pn;po;�d dcvclopmcn( is I•;.a(C cn FTR1S Pan-1 NO_ Darcd —_ The Froposcd Development! U Is NOT located in a Special Flood Hazard Arca (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERb4T IS REQUIRED). U Is loutcd in a Spt i,l Flood Flazard Arca. FIP..f.t zone desir aim, is IDJ-'i car Ila�d eleva(ion al the site_LS: FI. NGVD ('MSL) ❑ Uuavailablc ❑ The prvp,scd d-vc1opm.cm is lOCdled io a nuodway. FBP?,t Pancl tlo Dated r7 r-c -. i„ n .i i.--r �d-Li irn sl o-irr n"rr .r APPLICATION a PAGE ' OF a SECTION 4_.XWTI. fQ 1,1L I(dFGRMATlk REi)f_IIRED�T kc cumnlctcd by LOi:.r— ADtr1fNISTRATOR,] The applicant must submit the documents checked below before the applicauon can be processed. 0 A snc plan shovnng the locauon of .ill c.rastiug ;trn Ct UFCS, v:atef bodice, adlaeem roads, lot dimensions and proposed developmcm. U Development plans,drawn to scale, and speoficatipns, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the first noor, details of(loodproofmg of uatics located below the first floor and details of eociosures below the first floor. Also, 0 Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide Loo-year flood elevations if they are not otherwise available). Cl Ptatu showing the extent of watercourse relocation and/or landform alterations. Q Top of new fill elevation Ft. NGVD (NiSL). 0 Floodproofmg protection level (non-residewial ouly) Ft.NGVD (NISL). For floodproofed structures, applicant must attach cert:ication from registered engineer or m-chitect. 0 Certification from a reeistered cogineer that 0'. proposed acd ^.:y in a regulatory floodway nal not result in any increase in the height of Lhe 10)-year flood. A copy of all data and calodations supporting this fording must ilso be submitted. 0 Other. SF,CiION 5 PERMIT DETERMINATION (To be completed by LOt;AL ADMINISTRATOR) I have determined that the proposed activity. A. 0 Is B. O Is not in conformance with provisions of Lxal Law W L9 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED_ , DATE hcd_[d, the Local Adminuiralor may usuc a Dcvelopmem Permit upoo payment of designated fee If BOX B t5 cileckcd, the Lacal Administrator will provide & 'lutein summary of deticienci:s. Applicant may resise and resubmit an application io the 1cw3l zAmlmstralor or may request a bearing from (he Board of • - oITPLk AVION n f :.. ;F IF 1 -- a.PPF_-LI A.ppcalcd to Eoard rf Appeals' ❑ Y,-_s Cl Plo Hearmg date: Appeals Board Decision --- Approved? O Yes ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS ITo be submitted by APPLICAN-C before CcrtiLw[c of Compliance is issued The following information must be provided for proicct structmec. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete I or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest Boor, excluding piling and columns) is: FP. NGVD (MSL). L Actual (As-Built) Elevation of Boodproofmg protection is - FT. NGVD (MSL). NOTE: Any work performed pror to submittal of the above information is at the risk .af the Applicant. SECTION 7: o0mPLIA L(--E ,ACT1l)N o be onm_plctrd by L'Llcu A1MINIST24TOR'i The U)CAL ADMINISTRATOR will complete (bis seaion as applicable based o❑ ia:pe.aion rd the project to ensure compliance with the communitys local law for flood damage prevention. INSPIECYTONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE 13Y DEFICIENCIES? ❑ YES ❑ NO D.AT-E B'r DEFICIEN(-:IES' ❑ 7'ES Cl Ni) SECTION 8• CERTIFICATE OF OMPLIAN E(To be eomrleted 6y LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE BY: _ Attachment B SAMPLE CERTIFICATE OF COMPLIAt7CE for Development in a Special Flood Hazard AI'ea TOYM OF SOUTHOLD CERTIFICATE OF CONIPLIANCE FUR DEVELOPMENT IN .A SPECIAL FLOOD H.kZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO._ PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING O EXISTING BUILDING Cl VACANT LAND i1[F; 1 i0('Al� ADMINISTRATOR IS TO COIIIPLE'IT A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # 19 SIGNED:_ DATED:--- B. ATED: _B. COMPLUkNCE IS HEREB'i CERTIFIED WITH 'I IE. REQMREI.IENT`; OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # , DATED SIGNED:_ DATED: ( ( r,1 ) TOWN OF SOUTHOLD PRI07PERTY RECORD CARD OWNER STREET z17aJ VILLAGE DIST. SUB. LOT FORMER OWNER N E ACR. Cv-w s4er '- " A-�- S&c S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value +'8 LAND IMP. TOTAL DATE REMARKS C/GJ1 Q Q j c •� =_ sNb 55ovQ �l000 Tc-q �l000 l� Lw 9etv5903to �o� i27 G A5 �f. a�. well, X12,00 910o '?/i7 3 ,2 p Lf zo6 ECO 1 ad �tb iooD 1 700 2 27 Tillable 2, 1 q ;Ls-0 5z FRONTAGE ON WATER Woodl u�-j Z A Sd I p p FRONTAGE ON ROAD Q 6 DEPTH House Plot BULKHEAD Total k14 4 NQly,cl, trOTF tb ¢- 10 49M 1 .l b f 1b `1'l92 y 6 s °" j, �e 26-2-2.6 Accessory Bldg 02/02 — M. Id . B iv X z 7 4 3Z ,i Y= - Bath Extens' n IZK ''2 ISN 2, Basement Floors Extension 10'K (n -r,jExt. Walls lop uG.0 � �, Interior Finish 5 � Cl,.ow'.I >e , _ 153 H . gl k!ID Fire Place y Heat �,1 -AQP V *�4„t: +.o\y ;7 = 180 x •... I Icc> :'- ?„2 Pool Attic CO • ?, r Patio Rooms 1st Floor 2BO, JoA LQ �2 Breezeway Y lox8 08 Driveway Rooms 2nd Floor yry eni z \x.2-4 fpµ 373 IQQC Garage b zsr, v-i O. B. A4'Ro +oxay-ra 2S (pO C a Jim) lop- 74""1 r)Tc)f t MPLY ALL CFODES OF AP R VED AS NOTED N W ORK STIATE &TH OWN CODES DATE: S /i B P a I� AS REQUIRED AND CONDITIONS OF FEE: NOTIF -L Hy Sot THOLD TOWN ZBA BUILDINr, SPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE SDLTHOLD TOWN PLANNING 9W FOLLOWING INSPECTIONS: SOLTHOLDTOWN TFUSTEES 1. FOUNDATION - TWO REQUIRED —4 i FOR POURED CONCRETE -- N•Y.&DEC 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST OCCUPANCY OR BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE USE IS UNLAWFUL REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR WITHOUT CERTIFICATE DESIGN OR CONSTRUCTION ERRORS. OF OCCUPANCY "IMMEDIATELY" ALL CONSTRUCTION SHALL ENCLOSE POOL TO CODE UPON COMPLETION MEET THE REQUIREMENTS OF THE BEFORE "WATER' CODES OF NEW YORK STATE. FLOOD ZONE Zi %' UNuLrl"I FlGAlL COMPLY WITH CHAPTER " REQUIRED FLOOD DAMAGE PREVENTION SOUTHOLD TOWN CODE. N �' it I t I i 22' 0 6RRAGE N 32 0 ffl o E i I rx °_� N , �-2--a° 111 I WOOD DE=4' �;67�rL-CIZS AT OI674' fWDS 5oDN5 (�� # ,erD -q6-oo26 � jA-CCE 50,Zy PUrGDIAA+ -0WV MD1:Lt i JAM S � AAO) JR_ 8Y; �inrurA : i det.�ftA)QC> S7tC-ET rrvt ��o.r� , acs OaIC-/V7'- TOWN OF eOUTIfO-D � 3po/ cf. r POOL WALLS, BOND BEAM, AND FLOOR SHALL BE Iq" POOL DECK SHALL BE PAVED WITH MASONRY, OR j STEEL REINFORCED GUNITE CONCRETE. GUNITE 10„ WITH 4'OF POURED IN PLACE CONCRETE. m CONCRETE SHALL MEET OR EXCEED 4,000 P.5.1. 0 , Y ~ 26 DAYS. STEEL REINFORCING BARS SHALL `c� .z EXPANSION JOINT _ ow ° w (SEALANT IS OPTIONAL) J O Z. c _ y o ` CONFORM TO ASTM A615, GRADE 60. W p 1w- I.- w v LL = 6"X 6"FROSTPROOF CERAMIC TILE �'i:°` 'a a Q p a o a a o = WATER LEVEL 0CENTER OFC i i'•, ' i;., 1 :,;!M� .' .i1�` �•.. ' . 'ia d ate¢. n CEP TILE o.' n:' r - W w U IN POOL WALLS WITH A WATER DEPTH OF 5'-d'OR r \/� / U200 a-m LE85, RE-BARS SHALL BE PLACED HORIZONTALLY - • ., -Z AND VERTICALLY 012"O.C. : ;' /. \� � w r • � 4 IN POOL WALLS WITH A WATER DEPTH GREATER // MINIMUM SIZE OF COPING STONE SHALL BE 1 Vz" m THAN 6-0° ADDITIONAL VERTICAL 5AR5 SHALL BE THICK BY 12"WIDE m INSERTED TO CREATE VERTICAL BAR SPACING 0 6" O.C. THESE 13AR5 SHALL START FROM THE TOP OF �2 7'r:� 4"SAND BASE, WHEN NECE35ARYTO AID. THE WALL AND SHALL BE BENT AT THE BOTTOM TO a'�. +< ��\ DRAINAGE IN SLOW DRAINING SOIL N EXTEND 24"HORIZONTALLY INTO THE FLOOR. POOL WALLS AND FLOOR SHALL BE 7 THICK, AND ... . ' THE VERTICAL RE-BAR5 ® 12"O.C. SHALL BE BENT BOND BEAM SHALL BE 10"WIDE X 12"HIGH. V AS SHOWN IN THE BOND BEAM. ? 1 • 4- #4 BAR5 SHALL BE SPLICED TO FORM C/} UNLESS OTHERWISE SPECIFIED OR REQUIRED, #.3 ' CONTINUOUS REINFORCING WITHIN BOND BEAM BAR5 SHALL BE TYPICAL - Q NORMAL FLOOR REINFORCING SHALL CONSIST OF - - ;a 1 INTERIOR FIN15H ON GUNITE SHALL BE W'THICK Ll. RE-BARS PLACED AT RIGHT ANGLES (90') TO EACH TROWELED-ON "MARBLEDUST OTHER 0 12"O.C. �. RADIUS AT INTERSECTION OF GUNITE WALL AND r FLOOR VARIES. CRUSHED STONE, WHEN NECESSARY TO AID 0 `'• / DRAINAGE IF GROUND WATER 15 ENCOUNTERED IN j� ,•o ._ s . SLOW DRAINING SOIL cc . GUNITE POOL SECTION -i a SCALE: 1" = 1' - O" FIELD INSPECTION REPORT I DATE COMMENTS FOUNDATION(1ST) — ---- ------ — .6' ------------ -------- FOUNDATION(IND) m O a� ROUGH FRAMING& — — PLUMBING — -- -- r INSUL.ATION PER N.Y. — --- STATE ENERGY CODE _-- --- FINAL ADDITIONAL COMMENTS ]) — -- t'Z m -- — -- — ------ _Q x r - - L4 C r r x 0 o TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the follo%6ng,before applying? TOWN HALL L Board of Health__ SOUTHOLD, 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 C' /6 S Check Septic Form___ N.Y.S.D.E.C. Trustees Examined �� Y 20 Contact: .Approved 311! y ,20 Mail to: p( �fG I Disapproved a c _ 60046 IlQ 6y Phone:__Q- Expiration 20 s� 1 -ffuildiffg Inspector APPLICATION FOR BUILDING PERMIT Date 20 0 Ll 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature 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 cco in—+"Z Name of owner of premises �)�YAt / I S Qa a 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. - O F Cj 7( - - Plumbers License No. Electricians License No. Other Trade's License No. P 1. Location of land on which p oposed Ivor will be done: L 4 7J� d rcka! d 5 ©( 1 P✓1 l ------ House Number Street Hamlet County Tax Ma N . 1000 ection Block I Lot_ �•b Subdivision/ a0 n0 Filed Map No. 7 7A 9 Lot (Name) 2. State existing use and occupancy of premises and tended use jand o cupancy of proposed constru5tion: a. Existing use and occupancy !�'S rc{[�a� t o/,G od r b. Intended use and occupancy Q51 (0W 6M I / 3. Nature of work(check which applicable): New Building Addition Alteratio Repair Removal Demolition Other Work SWr nt rN r nod � (JAcription) 4. Estimated Cost C) 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 -- Rear Depth Height Number of Stories 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 q 78,I Rear Q RC2 Depth 7V 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO r✓ 13. Will lot be re-graded? YES NO_Will excess fill be removed from premises? YES ' ANO_ 14. Names of Owner of premises Address O c Cra hone No. Name of Architect _Address I L < 3 5(,Z hone No A�� — 2 3 7 Name of Contractor jo! l�I ler Address I A/I tV 3 5 Su�4Phone No. 6, e a2)— 2 .3 2 � 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO i•ll'— * 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: CO Y QF 1 /ht°a'es(, /o(�J"bqing4duly 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 is day of 20 0 Nor Public Signature of Applicant JUDITH . GOODSELL NOT.ARY PUBLIC,STATE OF NEW YORK No.01 G06068531 0UALIFIED IN SUFFOLK COUNTY MY COMMISSION EXPIRES JAN.7,2004P BUILDING PERMIT EXAMINER CHECKLIST DATE REVIEWED: 2 /J;1/04 APPLICANT: -A-At DATE SUBMITTED: 2 //7 /04 SCTM# DISTRICT: 1,000, SECTION: _ 2!7 BLOCK: 4 , LOT: SUBDIVISION: ADDRESS: 7 �j Urc-CITY: Ur ZONING DISTRICTA" CONFORMING? e5 BUILDIN PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP 254 f / C/0 Z- , INFO 5-F /BP -Z/C/0 Z- k'e, 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),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83 REQ. LOT SIZE: ACT. LOT SIZE: /4 REQ. LO ACT. LOT COV. REQ. FRONTd PROP. FRONT RES,). I 20 ACT. SIDE REQ. REAR 'r PROP. REAR ✓ Q-. HEIGHT PROP. HEIGHT PROJECT DESCRIPTION: AC ✓+ ESTIMATED PROJECT COST: �7*-��rRCHITECT/EN EER: WATER FRONT?.-- "'. SCRIPTION: /b° PANEL # FLOOD ZONE: T� APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: ES or NO, (B #): DTE: / / PERMIT#: TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: PRE-DE /1/ Y or N DTE: / / PERMIT#: SOUTHOLD TOWN TRUSTEE S or `DTE: / / PERMIT #: TOWN ZONING BOARD AP O A : YES r DTE: / / PERMIT#: TOWN PLAN. BOARD AP _ .w/.w ...1 PERMIT#: TOWN HISTO A): YES or O NEW YORK STATE CODE COMPLIANCE (SEE PAGE -2) or NO NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE )74.0 1. ( SF)- ( SF)= SFX $ =$ +$ +$la1 = $ /JT 2. ( SF)- ( SF)= SFX $ =$ +$ +$ _ $ 3. ( SF)- ( SF)= SF X $ =$ +$ +�$,,••r - F AL TOT : $ 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 LUMBER SPECIES AND GRADE:Y/N DESIGN LOAD CALCULATIONS: Y/N LIVE: Y/N DE4D: Y/N SNOW: Y/N SEISMIC: Y/N WIND: Y/N WINDOW ANP,'DOOR SCHEDULE: MISSLP-TEST REQUIREMENTS: Y/N �l EGRESS 5.7 S.F.: Y/N % i LIGHT 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: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) SCDHS Ref. # RIO-96-0026 NThe locations of wells and cesspools shown hereon are from field observations and or from data obtained from others. 0� P/ 01 c TEST BORING V. ' b BRAOAA4O TRMMSEEY SURVEY O F S' LOT C aeRoWN F AND SETTLERS AT OYSTERPONDS O( 00- e FXEDMAY 4+1981 FXENO. 7729 k1"° 30 AT ORIENT 7.6 — TOWN OF SOUTHOLD V r ` BO VERY E SUFFOLK COUNTY_ , N. Y. TO VERY D'G 0 i00 t COARSE SAND 1000 - 27- 02 - 2.6 J \O. .2 n i Scale: 1 =60 <,( a. ✓ a�// d" ' y00 e May 25, 1995 /h° FEB. 14, 1996 (SCDHS. INFO) 04f ;' Gt. s^ APRIL /9, 1996 (SCDHS REVISIONS) (�• 4° :�yti � �y1� 21^ Aug. 27, 1996 (foundation) I & Aug. 15, 1997(firxel) �R :.�� � Jr4y R 1 419 27, i99�/rcvi„oma) NOV. 29, 2000 ! Topo. 1 _ °p• AQ ,'/r.• 56. 9, (M.P 4 �• l,` l // v �p� Sept. 15, 200) (final gar.) JUNE 51 2002 r ra A Sn Lx l 4ti/ y �1 to rn 6 V "J PCGr459 11�^ - O p� k�� G 4 SF 9F 6100, O i 9 ZONE 0 I am familiar with /he STANDARDS FOR APPROVAL ` AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES �r and will abide by the condlfians set forth /herein and an the 5 - permit to construct. o ' (G kei4fQ sT� � � Rl F� 0 PO Y45,5, ��� R J ER el 8e/ ns r cl� 90. 01 k sz5 iiv /ova,< to XE F{m 6,2 0 V• G fa�k n. 1'9"> A.. l �,v y P Q a 55 R G \A R PRR J y CERTIFIED TO, JAMES F. HAAG, ✓R. SANITARY SECTION MERRILL LYNCH CREDIT CORP. CONGRESSIONAL ABSTRACT CO. , eI Ag ANY ALTERATION OR ADDITION TO TS SURVEY lS A VIOLATION OF SECTION TE09 OF THE NEW YORAf TATE EDUCAT/bN LAW EXCEPT AS PER SECTION 7_09-SUBdV/SION 2. ALL CERTIFlCA+TIONS ID M ARE VALID FOR TMS MAP A�/,��p COPIES ThC:RE- OF OAC.Y E N.Y.S. LIC. NO. 49618 SAS MAP OR COPIES BEAR THE WPAES,SEp SEAL OF TME SUPVEYOR 2 PROPOSED CONTOUR WHOSE SISNATLRE APPEARS HEREON iPECONAURVEYORS, P.C. ADpT1CNMGLY TO COMPLY WITH SAV Gw TFM' TERM AL TERM BY' ELEVATIONS AND CONTOUR LINES (63/1 765 - 5020 FAX !63/1 765 - 1797 MUST BE USED BY ANY AND ALL SLNVEYORS UTI 121 A COPY ARE REFERENCED TO N.G.V.D. OF ANOTHER SURVEYOR 5 MAP. SUCH AS 9YSPECTEO'AMD P. O. BOX 909 9ROu6Hr-To-DATE•ARE NOT av C� LMNCE WITH TRE LAW. FLOUR ZONES FROM FIRM 360813 0048E AREA - 9. 1049 Acres 1230 TRAVELER STREET SOUTHOLD, N.Y. 11971 95-179