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Home My WebLink About30700-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30987 Date: 06/16/05 THIS CERTIFIES that the building REPAIR Location of Property: 40495 MAIN RD ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 8 Lot 14.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 7, 2004 pursuant to which Building Permit No_ 30700-Z dated OCTOBER 14, 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 ROOF REPAIR TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS PER CERTIFICATION OF REGI WEILE, ARCHITECT DATED 6/7/2005 . The certificate is issued to NORMAN D ELSKY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Au orized Cignature Rev. 1/81 Form No.6 TORN OF SOUTHOLD 7^1 BUILDING DEPARTMENT { ` TOWN HALL 765-1802 f I Jl1N 13 W APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be tilled in by typewriter or ink and subnutted 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. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2i 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: L .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 L 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, Conunercial $15.00 Date. 7une 10, 2005 New Construction: _Old or Pre-existing Building: _(check one) Location of Property: 40495 to;n Aoad., Gdat, Dlaa Yrxlc Ch*h1 ld House No. Street Hamlet Owner or Owners of Property: 1`mm nL9ky Suffolk County Tax Map No 1000, Section 015 Block 8 Lot 14.2 Subdivision Filed Map. _Lot: Permit No. yptyp Date of Permit. 1D42y4 Applicant: na� wzila., ;tact Health Dept. Approval: Nk Underwriters Approval: Ik Planning Board Approval: 1A Request for: Temporary Certificate Final Certificate: XX (check one) Fee Submitted: $25.00 p licant Signature Qu, 68 3 L 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. 30700 Z Date OCTOBER 14 , 2004 Permission is hereby granted to : NORMAN D ELSKY 40495 MAIN ROAD ORIENT,NY 11957 for ROOF REPAIR "IN KIND" TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR; FLOOD PMT. INCLUDED at premises located at 40495 MAIN RD ORIENT County Tax Map No. 473889 Section 015 Block 0008 Lot No. 014 . 002 pursuant to application dated OCTOBER 7, 2004 and approved by the Building Inspector to expire on APRIL 14 , 2006 . Fee $ 250 . 00 T Authorized Signature ORIGINAL Rev. 5/8/02 /— -700 NOv SO 6 a TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [�INAL [ ] FIREPLACE & CHIMNEY [ } FIRE SAFETY INSPECTION REMARKS: DATE ��INSPECTOR i regi weile architect 905 aqua.jew, east mason. new ;ork, 11939 post office box 223 !'L '� - -rnatl ,reaiv.ei1e0,ao1 corn 631 477-9735 1nwN LF Building Department Southold Town P.O.Box 1179 Southold, New York 11971 7 June 2005 Re: Permit #30700Z 40495 Main Road, Orient Tax # 1000-15-8-14.2 Owner: Norman Elsky Dear Michael Verity, Building Inspector, This is to confirm and certify that all work performed on the above Residence has been completed according to all Governing Codes and under my supervision. This is an update to my Certification letter of 19 October 2004, as submitted to the Building Department. na-pectfully Submitted G,j(,L aEDARCN'T i welle, arch) REGI FPJ, * u m tt9rr OF t�'N regi weile architect 22 east 22nd street new york 10010 212-982-4884 box 223 • east marion, new york 11939 631-477-9735 Building Department Southold Town PO Box 1179 Southold New York 19 October 2004 ' Re: Permit and Amendment to Permit#30700 Z 40495 Main Road, Orient Tax#1000-15$14.2 A8,QtIIT=T5 GERTIFJCATIQ.N OF WQK EXISTING FOOTINGS REPAIRED As per Table 1805.4.2, Footings have been repaired and or replaced where missing and complies with requirements for support of one floor, 1.5'diameter concrete;depth below undisturbed ground surface 37. WOOD PORCH COLUMN REPLACEMENT Design Load Criteria: Dead Load: 40psf Live Load: 40psf Snow Load: 45psf Wind Load: Vm140psf; V3s 120psf Uplift and Exposure Category: Exposure B; Iw0.77;10psf as per 1607 Wind Pressure at Roof: 16.8psf normal to roof FASTENER TYPES Fastener types as per NYSC 1609.1.4 AT PORCH: Column to Footing: Simpson BC60 5.5x5.5x3.5H Floor Joists to Girders: Simpson Joist Hanger LUP28110d Ceiling Joist to Girder: Simpson Joist Hanger LUP26/6d Rafters to Girder: Simpson Hurricane Anchors H3, H2.5, w/8d Rafter/Girder/Column: Simpson H7/8d AT ROOF: Asphalt Strip Shingles have a minimum of 6 fasteners per shingle as per R905.2.6. Fasteners are Stainlesrs Steel min. 12ga. shank with 3/8" head, ASTM 1667, of a length to penetrate through roofing materials and a min. of 3/4" into the roof sheathing. Winter Ice Shield extends 24"to 36" and is in compliance with all governing codes. Where repaired, sheathing is 3/4" plywood to match existing material. ALL REPLACEMENT LUMBER All framing lumber is Douglas Fir or better, Fb=1400psi All porch framing lumber in contact with ground are be CCA I have supervised the above work and find it complies with the Governing Codes. Existing Framing has been reviewed and removed where deteriorated as per my supervision. Please See Drawings 1,2,1.1,2.1, and 3[as found in file]. I have contacted the Landmark Preservation Chairman and am in the process of obtaining a Site Survey indicating elevations and relation to Flood Plane. Respectful[ySutxTlf EDA 1"'riwJYiV� REG N9yC% i weile, arch' tk i m # 11 OF NEY't regi weile architect 22 east 22nd street new york 10010 212-982-4884 box 223 • east marion, new york 11939 631-477-9735 13 October 2004 Department of Buildings Southold, New York Re: Elsky Residence 40495 Main Road, Orient, New York 1000-015-8-14.2 Application for Permit to Install new Roofing Materials due to potential and ongoing water damage. To Whom It May Concern, This is to Certify that repair work on the above Residence will be in compliance with all Governing Codes including the Compliance for Development in Special Flood Hazard Area[C/C 93] and Compliance with the Guidelines of the Oysterponds Historical Society regarding work on a Structure with Landmarkable Value. At thigtime we will only install Roof Materials in order to protect the integrity of the Residence. Thank You, Respectfully Submitted 1Ekr'II •v, RE c;i qFo regi weile, hited It 11921 A�OF NEJ•1 regi weile architect 22 east 22nd street • new york 10010 212-982-4884 box 223 • east marion, new york 11939 631-477-9735 14 October 2004 Elsky Residence 40495 Main Road, Orient , NY Tax#1000-015-8-14.2 Amendment Re; Nailing of Roofing This is to Amend Application for Permit to install roofing replacement on the above Residence in coordination with Drawing^1.1 and 1.2. ule for Roofing to be as follows s per the Residential Code of NYS Section R905 in its Nailing S� entirety and specifically R905.2.6 as follows: Exception; Asphalt strip shingles shall have a minimum of six fasteners per shingle where the roof is in qne of the following categories: 1. The basic wind speed per figure R301.2[41 is 110 miles per hoyr or greater and the eave is 20 feet or higher off the ground. jWhe Basic wind speed as per R301.2[4] is 120 miles per hour or greater. Special wind zones. Wind Design Load as per Table 1609.3.1 of the Building Code of New York State Wind Load V3s=140; Vfm=120 Uplift exposure Category'C' Wind Pressure normal to slope= 17.0 psf Fasteners shall be Stainless Steel, min. 12ga. shank with 3/8"head, ASTM F 1667, of a length to penetrate through roofing materials and a min. of 3/4" into the roof sheathing. [R905.2.51 _ Winter shield[ice shield]shall extend 36". [24"required by code]and shall be installed in conformity with the Manufacturers G ' II governing Codes. \yS�R ARcy/l REG�N F END OF MEM ho? �� CA 1Y PE`/1� regi weile architect ` 22 east 22nd street nev, york 10010 ' '2T2-982-4884 S• box 223 - east marion, new york 11939. 631-477-9735 NORMAN ELSKY RESIDENCE 40495 Main Road, Orient, New York Tax map#1000-016-8-14.2 Residence Structure: 63'6" Deep; 35'0"Wide[this dimension includes front porch @11'6" Deep] CODE BUILDING NOTES Use/Occugancv Residential/One Family No Change Height 25'0" +/- Type Construction House: Wood Frame/Stone Foundation Porch: Wood Frame/Concrete Footings[16" round @ 3'0"deep at col's.] Site Elevation 10+ ; at 500year flood as per FEMA Means of Egress No Change Scope of Work Repair/Removal of all rotted and unsound materials related to Replacement of Roofing Material, Siding Materials. Repair and or replacement of window and door trim. Exposed materials will match Original House in Design, Scale and Materialg Design Load Criteria 1. Dead Load: 40psf 2. Live Load: 40psf • 3. Snow Load: 45psf 4. Wind Load: Vm=1-psf; V3s=120psf 5. Uplift and Exposure Category: Exposure B; Iw=0.77; 10psf as per ISBO1607.1 6. Wind Pressure@Roof; 16.8paf normal to roof Nailing/Connections Fastener Types as per NYSBC 1609.1.4 Porch Column to Footing: Simpson BC60 5.5x5.5x3.5H Floor Joists to Girders: Simpson Joist Hanger LUP28/10d f�4 ce . *Ceiling Joists to Girders: Simpson Joist Hanger LUP26/6d t� � 'rafters to Girder: Simpson Hurricane Anchors H3, H2.5, w/8d Rafter/Girder/Column: Simpson H7/8d Dormer To be determined after nature of damage and repair is revealed by opening roofing. Energy Design Conditions Degree Days=600 Design Temperature= 72 Degrees Indoor and 10 Degrees Outdoor All new installation to conform to the New York State Energy Conservation Code. I � / t regi weile architect gEREDARC c, 22 east 22nd street new yo 10010 * > m 212-9142-4884 box 223 east marion, new yolk 11939 631-41V7-9735 Srq NO l C'1•IANGE � CERTIFICATION NAILING & CONNFC IONS REQUIRED. CONSTRUCTION SHA NEW ROOFING ME THE REGI ,E VEr,TS 0 THE DESOF NEW YORK STA E. O CCUPANCY OR pitch and line of roof to rein SE IS UNLAWFU WITHOUT CERTI -- OF OCCUPANCY pitch I ,��,, as exK+'4ftFING ' QAPPROVED AS NOTE D EXISTING DORMER DA TE:14�9/y-- B.P.i o 7�" FEE: 232 BY: 6 N TIFY BUILDING DEPARTME IT AT 7 •1802 8 AM TO 4 PM FOF THE FOLLOWING INSPECTIONS: line of porch below 1. FOUNDATION - TWO REOU ED FOR POURED CONCRETE 2 ROUGH • FRAMING 8 PLU NG 3 INSULATION 4 FINAL • CONSTRUCTION ST BE COMPLETE FOR C.O. NEW ROOFING CONSTRUCTION SHALL EET TH EOUIREMENTS OF THE CO OF N ORK STATE. NOT RESPONru ESIGN OR CONSTRUCTION ERROR 351011 I ROO(FJPW le-- 1/8"= 1 '0" E SKY RESIDENCE �4 — - --- -;—— 40,V95-main n Rad, ;enNY t reg+ Weile architect 22 east 2 \St�RE04R 2nd street . new QFC'aN REciycyr York 10010 box 223 • east Marion, newlYo k 11989 , m 631-477-9735 s i r i I Naw 3/Shing es of Dormer Naw New p F f Its fairas r" . NeW ling tri @ was r.4d. exi Al, j rd6f Ai'ofiles to ra'+tiin unc Shingles by �4ed Teed i' WCM Mass AWeathered ghak Ha� �( 305Ibs � (1 s4uare I aniC felt A5 �2S?AS'MM3018-1 es IROOF SECTION Scale. 21899 = 1 ,0„ ' 40495 Main p RcW, Orient, NY j-WI'H T. TARRY I = y P O- flux 1179 TOWN CLE" un �,I C,Ulhnld NC%, l ) Ult 1 �� Fax (S I(\I 765. i I EGlsfn.1.n OF ern). srr,ns)cs �� ICS IR, Tcicr6u nc 15161 76(. nlnn RlnG f-. OFFICER 1\ RECORDS M"AGEMENT OFFICER FREEDOM OF INFOfUL1lION OFFICER OFFICE Of THE TOWN CLERIC 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 11 of. the Code of the Town of Southold: "Floodplain Development Permit r %.pplir_ation" ( FDP(93) ( , and "Certificate of Compliance fair Develcpment in Special Flood Hazard Area (CIC(93) ) . 7 n L tE— _ t TOVS;10 F S0giI10LD Judith T . Terry Southold Town Clerl•. August 2S , 1993 "•t APPLICATION M PAGE I of a TOWN OF SOUTHOLD FLOODPLAIN DEVLLOPNIEN'r PEItpIPT APPLICATION This form is to be filled out in duplicate. SECTION l GENERAL PROVISIONS (APPLICANT to read and si¢nY 1. No work may start until a permit is issued. 7 The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 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. 6. I,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE,TO THE BEST OF M [QJO�E, TRUE AND ACCURATE. (APPLICANT S SIGNATURE)_. DATE �GS 13 1 hit— SECTION 2 PROPOSED DE�ELOPP EPTTt?x('c Cieo ary kPPLICAI II NAME ADDRESS b TELEPHONE AP P LI CANT BUILDER — ENGINEER ar PROJECT LOCATION: To avoid delay in procr._ssing the appfiation, please provide enough information to easily identify the project location_ Provide the street address, lot number or Icgal description (attach) and, outside urban areas, the distance to the nearett interscrting road or v.cl14no%u landmark A sketch attached to this application showing Ibc proicct location would be helpful Taxi Map l Un0-015_8-14 2 _ 40495 Main Rmad, nr;ant rNNe Ynrk FDP(931 i APPLICATION PAGE2OF4 DESCRIPTION OF WORK (Check all appGcablc boxcs)- _ _ ___ A STR -fURAI. DEVELOPMErfT ACTIVITY STRUCTURE TYPE O New Structure ;Residential (1-4 Family) ❑ Addition O Residential (More than 4 Famdy) ❑ Mteratioa ❑ Noo-residential (FloodprooCmg? O Yes) O Relocation O Combined Use (Residential & CommerdaJ) Cl Demolition P O Manufactured (Mobile) Home (In Manu- YlReplacement of ROORWi factured Home Park? O Yes) ESTIMATED COST OF PROJECTS Z WO B. OTHER DEVELOPMENT ACTIVITIES: O Fill O Mining O Drilling O Grading O Excavation (Except for Structural Development Checked Above) - O Watercourse Alteration (Including Dredging and Channel Modifica(ions) O Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction O SuF,,division (New or Expansion) Cl lydrsidual Water or Sewer Systcm ❑ Other (Please Specify) A.hcr completing SECTION ?, P.PPLlf,APIT shoidd submit lorm to Lac l Administrator for revie - SECTION J: FLOODPLAW DETERMINATION (To be completed by LA)CAL ADMIMSTRATOR) The proposed developmonl is lo. ted on FIR1,1 Pancl No. Dared The Proposed Development O Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located in a Special Flood Hazard Arca. FIRM zone dsignation is 100-Year flo�l elevation al the Silc u: Ft. HGVD (MSL) O Iluavailablc ❑ The proposed dcyclopmenl is bidsrd .o a Iloodw,ny. FBF1.1 Paocl No. Datr.d ❑ ,r. $.:ein;n •I Irr .r•iLirnr�l n : r „I -n Gr FD DATE • .r APPLICATION ,a PAGE a OF 4 SE PION 4' ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATORI _ The appGcant must submit the documents checked below before the application can be processed: O A site plan showing the location of all ecisting structures, water bodies, adjacent roads, 101 dimensions and proposed development. ❑ Devclopmepl plans,drawn to scale, and spcaficatiptu,including where applicable: details (or anchoring structures, proposed elevation of lowest floor(including basement), types of water resistant materials used below the fust Boor, details of floodproofmg of utilities located below the first floor and details of enclosures below the fust floor. Also O Subdivision or other development plans(If the subdivision or other development eezceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). O Plans showing the extent of watercourse relocation and/or landform alterations- 0 Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection level (Boo-residen(ial only) Ft.NGVD (MSL). For floodproofed structures, ",ppGcaot must attach certification from rtgictered engineer or architect. r ❑ Cerifficatioa from a registered enpnec-r that the proposed ac[ivitry in a regWatory floodway will uol result in any increase in the height of Lbe 100-year flood. A copy of all data and calodations supporting this fording must also be submitted. ❑ Other. SECTION 5 PERMIT DETERMINATION (To be completed by LOCAL ADNtIN[STRATORI I have determined that the proposed activity. A. O Is B. O Is not in conformance with provisions of Local law 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED__ , DATE Lf 8-Q -• i,t_h d.ed, (he Local Admiws(rmor may iswc a Dcvdopmcot Permit upon payment of designated (cc If BOK B s checked, (hc Local ,idministralor wall provide a wTi(tcD summary of dchucncics. Applicant may resise and resubmit an application io th,: U-cal A.dministrainr or may request a bearing from Ibe. Board of Appeals APPLICATION a _ PAVE i OF a APPEA.IS. .Appealed to Board of Appeals? ❑ Yes O No Hearing date: -- — ppe �tppravcd� -Yes -- Couditioos SECTION 6' AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Comolianee is issued The following information must be provided for project structures. 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 an Coastal High Hazard Areas bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FI'. HCVD (MSL). L Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (?ASL)- NOTE: Any work performed prior to submittal of the above information u at the risk of the Applkant. E$ MON 7: COMPLGINCE ACTION (To be completed by LOCAL ADh11NISTRAT Rj The LOCAL .ADMINISTRATOR will rompletc this section as applicable based oo in-pecxioo of the proieet to ensure cOmphance 'with [he communitYs local law for flood damage prevention. INSPECTIONS: DATE BY_ DEFICIENCIES? ❑ YES O NO DATE BY _DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? O YES Cl NO aECTION 8: CERTIFICATE OF COhIPL"CE(To be comRleled by LOCAL ADAIfNISTRATORT Certificate Of Compliance issued: DATE BY: r 1 • r 1 • 1 Attachment B SMP WE CERTrF!CATE 'JF COMPLIANCE for De,relopmant in a Special Flood Hazard Area rr 'r r • i , 1 TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPNIENT IN A SPECIAL FLOOD HAZARD AREA (O ER MUST arTATN--T IIS_CERT__IFICATE�__ PR LASES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: p NEW BUILDING IJ EXISTING BUILDING Cl VACANT LAND i THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COhIPLLANCE IS HEREBY CERTIFIED WITH THE REQLRR-EMENTS OF - LOCAL LAW # 19 SIGNED:_ — DATED:_ B. CO.APLIANCE IS HEREBY CERTIFIED WITH TE E REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # DATED SIGNED: _ DATED:_ Ci ( ( 93 ) FIELD INSPECTION REPORT DATE COMMENTS () Q b Q m FOUNDATION(1ST) FOUNDATION(2ND) m � O kA A ROUGH FRAMING& m m PLUMBING �o r cn INSULATION PER N.Y. 3 STATE ENERGY CODE IV OL ff _ FINAL [� ADDITIONAL COMMENTS Z m z � m ro 2 a r � z i v ro TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT' 13 2001' Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAR: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. )D200Ti Check Septic Form N.Y.S.D.E.C. Trustees Examined I°/9 , 20 0 Contact: Approved _moo �f ,20_0_�_ Mail to: regi weile, architect Disapproved a1c _ po 223 east marion, ny Phone: 631 477 9735 Expiration 1 I q ,20 ()�, 'Building Inspector APPLICATION FOR BUILDING PERMIT Date 13 October 2004 20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 an regulations, and to admit authorized inspectors on premises and in building for necessary inspections. R Gr TFO ( e n m e,if a corporation) > I ajlgg�a £applicant) 4NFN0 State whether applicant is owner, lessee, agent, architect, engineer, general contracto , cian, plumber or builder Architect Name of owner of premises ploLman El sk} (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: 40495 Main Road Orient House Number Street Hamlet County Tax Map No. 1000 Section oI,S Block a lv '196t1 a Subdivision —� Filed Map No. W" Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Residentially eaident}al One Fermi b. Intended use and occupancy DIG CbAnge 1r � 3. Nature of work(check which applicable): New Building Addition Alteration Repair roc Removal ,,,, Demolition Other Work new r,,f;nai'bnly_ remove existing (Description) 4. Estimated Cost Qin nnn nn Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units one Number of dwelling units on each floor If garage, number of cars nnnL 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 35 0.. Rear 35,0.. Depth 631611 Height zs' Number of Stories 2 Dimensions of same structure with alterations or additions: Front NO CHANGE Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front No CHANCE Rear Depth Height Number of Stories 9. Size of lot: Front 23n 10" Rear y30'0" Depth 221 'O" 10. Date of Purchase 1gnn Name of Former Owner 11. Zone or use district in which premises are situated Residential 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO XX 13. Will lot be re-graded? YES NO XX Will excess fill be removed from premises? YES NOS_ 14. Names of Owner of premises N.Elskv Address 40495 main Rd_ or;&wne No. Name of Architect rogi teres t e Address p. 223 east fflaEjeFI.Phone No 477-9735 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, SO H14 WN TRf EES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property Wolin 300 feet �a 'dal wetland? * YES NO * IF YES, D.E.C. P ITS gAY BE:REQUIRED. 16. Provide survey, t� scale;Uecurate,14roundation plan and distances to property lines. 17. If elevation at any point on.propenyts at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) regi weile, architect being duly swom, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the arQhitQGt (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. Sw to before me this day of 2064 WIT- otary Public ignature of Applicant BONNIEJ.DONOSIO Notary Public,Stat Of New% No.OID06095328,Suffolk A-- Term Expires July 1,20 1, 1 ' Dale. Reviewed: /o AppllcantJ Owners Name Date Architect/ Submitted: io 3 Engineer: SCTM #: 13iock _-- Lot: � 17istrict: I,Q�� Section: — Subdivision ( / Name: project I..ocadon: $in&le&separate Required �— p Icy. certiOcatlotL' ,13 Rte' �o Actual: (IOt size: !rating Ustrict� p Rcq ({tcar Yard — proposed- -( Reg• proposed:_-r--3 (Side Yard j Proposed: —� irmat Yard J project Description: �ertnit . , a r fTTf Suffolk County Health Dept. ------- _f -______-- / Naw York State Town Trustees Town Zoning Board approval: --- Town plamdug Board stpproval: Flood Plano Elevation IT? Flood Zoae: 9 ri