HomeMy WebLinkAbout31216-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31108 Date: 08/15/05
THIS CERTIFIES that the building ADDITION
Location of Property: 680 MEADOW LA MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 115 Block 4 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 7, 2005 pursuant to which
Building Permit No. 31216-Z dated JUNE 22, 2005
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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to RUTH L KNUDSEN & OTHERS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Auth ized Signature
Rev. 1/81
O .
Form No.6
TOWN OF SOUTHOLD r_----
BUILDING DEPARTMENT
TOWN HALL f
765-1802 6 2005 , I
APPLICATION FOR CERTIFICATE OF OCCUPAN Y� j II
This application must be filled in by typewriter or ink and submitted to the Building�epa\tt with fhetYdllowingt
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 $15.00
Date. 4 . Zoe 5
TBOVF GROOUD PCNL
New Construction: Old or Pre-existing Building: ✓ (check one) %t>D%rlo\J To Ext St
85 .17EC
f -80\LT
Location of Property: VZ90 NF_N )Cx J I G\.>E- T-o t _
House No. Street Hamlet
Owner or Owners of Property: {?$r�Ee�Mlt��_ C9. ?r�EnKup��i
Suffolk County Tax Map No 1000, Section 115 Block if Lot a
Subdivision �-- I-J� - Filed Map. Lot:
Permit No. 31 -M, Date of Permit. Applicant: P1,I) p��e r ry�.�tc q -{1c IS\ --
Health Dept. Approval: 01)' . Underwriters Approval: r>>k
Planning Board Approval: p4A .
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $
6&G 0 7/Y Applicant Signature
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. 31216 Z Date JUNE 22 , 2005
Permission is hereby granted to:
RUTH L KNUDSEN
PO BOX 548
MATTITUCK,NY 11952
for
CONSTRUCTION OF AN "AS BUILT" DECK ADDITION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR
at premises located at 680 MEADOW LA MATTITUCK
County Tax Map No. 473889 Section 115 Block 0004 Lot No. 027
pursuant to application dated JUNE 7 , 2005 and approved by the
Building Inspector to expire on DECEMBER 22 , 2006 .
Fee $ 300 . 00
A� I��[f/
Authorized Signature
ORIGINAL
Rev. 5/8/02
765.1802
z - BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ( FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAF INSPECTION
REMARKS:.
DATE ���� �D� INSPECTOR /i'
ITECNOLOGIES
ARCHrrBCTM PLANtaM COfa=UCTM9MVX=
13/05MelaRaed.A11dWc , New Park 11952
6312%1129 f¢63129&1128
June 1, 2005
Town of Southold
Building Department
Town Hall
Southold, N.Y.
Re: Pete Boeckmann
T.M. # 1000— 115-4-27
To Whom It May Concern:
We certify that the structure of the as-built deck is in full compliance with the New York
State Building Code. The existing footings of the deck are poured at no less than 36"
below grade. The footings are p. concrete on top of 18" footings.
Please call our office if you have any questions.
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ITECNOLOGIES
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631.2%.1129 Eu:631.296.1128 -
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June 21 , 2005
Southold Town Building Department
Southold, N.Y.
Re: Mr. Pete Boeckmann
680 Meadow Lane
Mattituck, N.Y. 11952
S.C.T.M # 1000-115-4-27
To Whom It May Concern:
As per the building code of Southold requirements we certify that the deck railing of
the property meets the 36" ht. requirement.
The attached pool deck is constructed out of 2 x 6 F.J. with 4 x 6 posts. There is a
4' h. wood fence with a self latching gate around the front face of the pool connecting to
the deck.
If you have any additional questions please feel free to call our office at 631-298-1129.
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FIELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION (1ST) -
-------------------------------------
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FOUNDATION(2ND) n
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ROUGH FRAMING&
PLUMBING
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INSULATION PER N. Y. - -
STATE ENERGY CODE
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FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT �}
Town Hall v I
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 31217 Z Date JUNE 22 , 2005
Permission is hereby granted to :
RUTH L KNUDSEN
PO BOX 548
MATTITUCK,NY 11952
for
CONSTRUCTION OF AN "AS BUILT" ABOVE GROUND SWIMMING POOL IN THE
REQUIRED REAR YARD, FENCED TO CODE
at premises located at 680 MEADOW LA MATTITUCK
County Tax Map No. 473889 Section 115 Block 0004 Lot No. 027
pursuant to application dated JUNE 7, 2005 and approved by the
Building Inspector to expire on DECEMBER 22 , 2006 .
Fee $ 300 . 00
Authorized Signature
ORIGINAL
Rev. 5/8/02
765.1802
< ' BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAF INSPECTION
REMAR71S:
DATE t'� �� INSPECTOR '�' /
FIELD INSPEC'XON REPORT DATE I COMMENTS W
_ ^o
FOUNDATION (IST)
-- a
------------------------------------
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FOUNDATION(2ND) --- �m
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ROUGH FRAMING& �j a
PLUMBING I(e
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INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS Z
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TOWN OF SOUT14OLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT 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
FAX: (631) 765-9502 Suney_
ivww. northfork.net/Southold/ PERMIT NO. 319/10 Check
Septic Form
NN.S.D.E.C. _
i Trustees
Examine) 200) Contact:
APpro%ed . 20Q- Mail to:
Disapproved a c
Phone:_
Expiration __ 1_a1.l . "oQ
Building Inspector
t
T �� PPLICATION FOR BUILDING PERbIIT
i Date n 20 D�_.
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 prernises 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.
.-\)PLICATION IS HEREBY NLA DE 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.
�a A t t nuc i1� 2 �Q
" CLk- Lk-) _
(Signature of applicant or name,if a corporation,) `
P. o .lba &- g/6- oaUTlOej-
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
A� ,J _
Name of owner of premises QErc )(1a1MnA11
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
LAI a�P( lA(� ClnP`o
(Name and title4f 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:
L)sG f 1E 1)Lmo l-A+3G Mt1't 1 ITOC*�/
House Number Street Hamlet
County Tax Nlap No. 1000 Section 115 Block 11 Lot J7
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construedon:
a. Existing use and occupancy zJECk.
b. Intended use and occupancy 7Et
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work ftp,- ¢xot L_-` p, t fj !Flc)c�
",O1o2 jo �)0o3" (Des ription)
4. Estimated Cost — Fee r
(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 100 Rear 1 9 S.U fl t Depth X39'
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated `p,– 40
12. Does proposed construction violate any zoning law, ordinance or regulation^ YES_N0=
13. Will lot be re-graded? YES`NO`Will excess fill be removed from premises? YES_N0=
14. Names of Owner of premises lt ba ,n=a A _Address .G• X 59 M Phone No. ,3q'g - 5I N
Name of Architect W_Qy. PuTy 0 Address ( phone No 6113l-2qg-1,94
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO --
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland° * YES NO —
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY 01`A\1CFi ).
��A i 2�6u�S K/r being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the Q>1
(Contractor, Agent,Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of 20 OS_
otary blit Signature of Applicant
LINDA J COOPER
NOTARY PUBLIC,State of New York
NO.01 C04822583,Suffolk Coupty
Term Expires December 31,2011(2
TORN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following, before applying?
TOWN HALL. Board of Health
SOUTHOLD, NT 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
w%v%v. northfork.net/Southold/ PERMIT NO. �✓fal1� Check_
Septic Form
N.Y.S.D.E.C.
' / Trustees
Examined_ �" 20 015/ Contact:
Approved t1 ,20__p__5 Mail to:
Disapproved a c_
Phone:___
Expiration ' 7'3;200{°
Building Inspector
t APPLICATION FOR BUILDING PERMIT
Date ' 20 US
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, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
MRWBOM CEpnFICATE 'IMMEDIATELY" 11a iels-Ar-�
ENCLOSE POOL TO CODE (� Si gnatu of applicant or name,if a corporation)
REWIRES UPON COMPLETION / p
BEFORE "WATER" _
(Mailingaddressof applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
ALL CONSTRUCTION
dL%P—�— UIREMENTS OFMQ Ill
Name of owner of premises t 0F®E I
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer FEE: a L BY:
�j NOTIFY BUILDING DEPARTMENT AT
(Name and title of corporate ( 765-1802 8 AM TC 4 PM FOR THE
FOLLOWING INSPECTIONS:
USE IS UNLAWFUL 1. FOUNDATION - TWO REQUIRED
Builders License No. FOR POURED CONCRETE
Plumbers License No. 1 T rERTicIrATE 2, ROUGH - FRAMING & PLUMBING
Electricians License No. 3. INSULATION
Other Trade's License No. 4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
1. Location of land on which proposed work will be done: REQUIREMENTS OF THE CODES OF NEW
( && M�,;A-'s-�cm,., NIIT—, vvu % STATE NOT RESPONSIBLE FOR
House Number Street "WON OR CONSTRUCTION ERRORS.
County Tax Map No. 1000 Section ( `5 Block ){ Lot '�;2 7
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy I S t ,, W u %V)atr' G ejLX3 V-� 12V;k3ceD L+V MXQ0
b. Intended use and occupancy I k 4)01 I 'k C) w�Rt7�trra�
3. Nature of work(check which applicable): New Building Addition Alteration_
Repair Removal Demolition Other Work 1S. I Gnnr�,"rls.:)C- _
4. Estimated Cost Fee
R2V,_ -f0 (Description)
(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 1W' • Rear 1& -4 y I Depth $� -
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_N0=
13. Will lot be re-graded? YES_NO Will excess fill be removed from premises? YES N0=
14. Names of Owner of premisJs r_ &,,E k a,::,c�Address P p. N 4W,t,40 kr.L Phone No. ^ sk -
Name of Architect c)"A-eo Address P.tO mos 4`'r NrFmToejLPhone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO —
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES ^ r. Q nrVIM!
* IF YES. D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distaTices i p'roo -, 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)
COUNTYOFCtt . )
�c�pt��1�6flac��zsK f#. being duly sworn, deposes and says that(s)he is the applicant
(Name.of individual signing contract) above named,
(S)He is the O,toilLz -11 '
-- — U (Contractor,Agent, Corporate fife r, et . `
' I
of said owner or owners, and is duly authorized to perform or4ve performed the said x or and to make and file this application;
that all statements contained in this application are true to, of his knowledge and&kef; and that the work will be
performed in the manner set forth in the-ap)Slication filed th�et vit'
Sworn to before me this
—day of �fih d" 0 &F
o aryPGbhc Signature of.Applicant
LINDA J COOPER
NOTARY PUBLIC,State of New Yo,
NO.01CO4822563,Suffolk County
Tartu ExPirea December 31,20_(l
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SURVEY OF PR OPEN T Y SITUATE: s 83 22' 10" E LOT 48 p x a
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LOT NO . 47 r 200.0o' o Z
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TOWN OF SOUTHOLD
SUFFOLK COUNTY , N . Y . LOT 47 0 Lo
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f 7 f AS-BUILT NEW DECK m 0
SCALE. 1 — 20 aas AREA O T - - — ee Lu Y
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INFORMATION TAKEN FROM SURVEY
242
PREPARED BY YOUNG & YOUNG a
LAND SURVEYOR DATED APR. 2 1975 COEXISTING DECK (>]
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FTNGS POURED @ 36•' + BELOW (n
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APPROVED AS NOTED
x6 4"X4'
ez^x9" Posr AS-BUILTAREA
° DATE o'i BP Y 3 r—d6
w
FEE 4
BY
Zi x "2'x9^ NOTIFY BUILDING DEPARTMENT A-
S•x 16^x 12-D 2•X fi. 0 FOLLOWING INSPECTIONS;765-18U2 8 AM TO 4 PM FOR THE
FOOTING la 42" 0
"LOW GRADE XIS'j @ 6 J POST 18' 0 1 FORNPDATION - TWO OU ED CONCFEEQUIRED
°0 TE
2. ROUGH • FRAMING 8 PLUMBING
16"Xi. X12"O.
m 3. INSULATION
FOOTING A42^ < TOP OF DECK OFF o 4. FINAL - CONSTRUCTION MUST
enP�L°RADE a FIN GRADE @ 2'-i o"H, ° BE COMPLETE FOR C.O.
S' z RAIL TOP OF DECK @ as^ H N� ALL CONSTRUCTION SHALL MEET TI
m REQUIREMENTS OF THE CODES OF Ni
a S m YORK STATE. NOT RESPONSIBLE R
DESIGN OR CONSTRUCTION ERROR
N
N N
SCALE.
r
<�pLEO ARC
s ' = 20'
��\gN4gNK•NO7gAp\� OwG. NAM
AS - BUILT DECK FRAMING ¢ SITE PLAN ALL CONSTRUCTION SHALL
j fid„
4 _ MEET THE REQUIREMENTS OF THE
DWO. NO. CODES OF NEW YORK STATE.
sT9rFOFNEe A. SI I E
CERTIFICATION OF
NAILING&GONNECT IONS
REQUIREL.
- - - - OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATI
OF OCCUPANCY