HomeMy WebLinkAbout31525-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31233
THIS CERTIFIES that the building ALTERATIONS
Date: 10/24/05
Location of Property: 7390 GREAT PECONIC BAY BLVD LAUREL
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 126 Block 11 Lot 11
Subdivision
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 11, 2005 pursuant to which
Building Permit No. 31525-Z dated OCTOBER 13, 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" ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to MATTITUCK ASSOCIATES, LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 2074356 10/06/05
PLUMBERS
Authod Signature
Rev. 1/81
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
61(o 47-594336
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APPLICATION FOR CERTIFICATE OF OCCUPANGI_ s
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. MAW127: L9 2.005New Construction: Old or Pre-existing Building: (check one) `
Location of Property: T390 FgcpNAG BLVD oomw L K—_
House No. Street Hamlet
Owner or Owners of Property: "A= N ck A6orAoci*ms LL C
Suffolk County Tax Map No 1000, Section Block L Lot ti
Subdivision Filed Map. Lot:
Permit No. � 15 S Date of Permit. Applicant:
Health Dept. Approval: _ Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ es.UO
6Z - 67135
Ca-?-3i�?33
IczApp t Signature
BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET — NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of upon premises owned by
TIMOTHY BOWE
C/O ABCO
50 MIDLAND AVENUE
HICKSVILLE, NY 11801
Located at 7390 PECONIC BAY BLVD MATTITUCK, NY 11952
Application Number: 2074356
Section: 126 Block: 11
TIMOTHY BOWE C/O ABCO
50 MIDLAND AVENUE
HICKSVILLE, NY 11801
Certificate Number: 2074356
Lot: 011 Building Permit:
BDC: nsll
Described as a Regldential 0-599 su eft. occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, describecTeMew, located in/on the premises at:
Second Floor,
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard
promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 6th Day of October, 2005.
Name CITY Rate Rating Circuit Type
Miscellaneous
2nd floor over garage
as built -1985
Wiring and Devices
Outlet
3 0 Fixture
Fixture
3 0 Incandescent
Outlet
18 0 General Purpose
Receptacle
12 0 General Purpose
Switch
7 0 General Purpose
An as built inspection, of the delineated electrical installation, determined that an obvious hazard is not present and the installation is believed to
be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system.
seal
1 of I
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
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. 31525 Z Date OCTOBER 13, 2005
Permission is hereby granted to:
ASSOCIATES MATTITUCK
50 MIDLAND AVENUE
HICKSVILLE,NY 11801
for
AS BUILT ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR. ADDITIONAL CERTIFICATIONS AND SCHD APPROVAL MAY BE REQUIRED
at premises located at
7390
GREAT
PECONIC
BAY BLVD
LAUREL
County Tax Map No. 473889
Section
126
Block
0011
Lot No. 011
pursuant to application dated OCTOBER 11, 2005 and approved by the
Building Inspector to expire on.
Fee $ 300.00
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ]
FRAMING/ STRAPPING FINAL /et- I
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
LIE �n
DATE / _ % - S INSPECTOR " Y �
31 Sa-s 2.
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING j FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
,
DATE /� r� / �� INSPECTOR /
A
y
w
FIELD INSPECTION REPORT
DATE
COMMENTS
FOUNDATION (1ST)
tA
y
------------------------------------
---------------------------------FOUNDATION (2ND)
FOUNDATION
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ROUGH FRAMING &
PLUMBING
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INSULATION PER N. Y.
STATE ENERGY CODE
y
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FINAL
p':
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL i
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www, northfork.net/Southold/
I
10
Examined '3 20 'J
Approved t� 205—
Disapproved a/c
Expiration , 20
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval_
Survey
PERMIT NO.S/ho?J Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date
October 11, 2005
plication 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.
µkQfTyc�L�.s5c�C1A'I�� L�,�
(Signature of applicant or name, if a corporation)
Sol-tloL�o Ac�E,6���lI�E I�IU ILO�I
(Mailing address of applicant) —
—
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Owner
Name of owner of premises Tim Bowe
(As on the tax roll or latest deed)
If O is ' a corporation, signature of duly authorized officer
and title of corporate
Builders License No.
Plumbers License No. _
Electricians License No.
Other Trade's License N
1. Location of land on which proposed work will be done:
7390 Peconic Bay Blvd. Mattitu
House Number Street Hamlet
County Tax Map No. 1000 Section d.(o Block L Lot 1
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premisesand intended use and occupancy of prop -sed c -instruction:
a. Existing use and occupancy Residential
Residential
Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration X
Repair Removal Demolition Other Work
4. Estimated Cost $5,000.00
Fee
(Description)
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front 25 Ft Rear 50 Ft Depth 94 Ft
Height 22 Ft Number of Stories 2
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories 2
8. Dimensions of entire new construction: Front 25 Ft Rear 25 Ft Depth 24 Ft
Height 22 Ft Number of Stories 2
9. Size of lot: Front 100 Ft Reay. 104.38 Ft Depth 342.64 Ft
10. Date of Purchase 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 X__
13. Will lot be re -graded? YES NO X Will excess fill be removed from premises? YES NO
14. Names of Owner of premises Tim Bowe Address 7390 Peconic Ba1yhA;4.
Nameof ArchitectGlueckert & Wieber Address 20 Peachtree Ctghone No 631-737-4747
Name of Contractor Address
No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X
* 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 X
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
Tim Bowe
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the Owner
(Contractor, Agent, Corporate
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 pefore me this
-7~ day of 04:70 B FX 20 OS
N61ary Public
Phyllis Fft
40twY FOb#c SWe of WW ywt
No. OnD3
FR60a
��6
D
Signature of Applicant
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FOLLOWING INS CTIONS: TTT
1. FOUNDATION -TWO REQUIRED
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REQUIREMENTS 9FTHE'CODESOFNEW
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BUILDING PERMIT EXAMINER CHECKLIST
DATE REVIEWED: /0113 /ft �
APPLICANT: ,-, DATE SUBMITTED:a/21
SCTM# DISTRICT: 1,000, SECTION: ka(�,BLOCK: _�, LOT: SUBDIVISION:------_
ADDRESS:- �j PPC0n,L (,„ CITY: ZONING DISTRICT: CONFORMING? )VO
BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP IIy -Z / C/0 Z-, INFOS 1=n, r�
BP -Z / C/0 Z- , INFO . BP -Z / C/0 Z- , INFO
SINGLE & SEPARATE CERTIFICATION-REQUIIRD NOTES:
LOTS 40,000SF -100-24. Lot recognition. (CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25. Merger.(A nonconforming at anytime after 7/1/83;
REQ. LOT SIZE: ACT. LOT SIZEQ. LOT COV. ACT. LOT COV.
REQ. FRONT PROP. FRONT REQ SIDE 2,5 ACT. SIDE
REQREAR PROP. REAR REQ. EIGHT PROP. MIGHT
PROJECT DESCRIPTION: ABU/Ci -70`71-t iS i /_ 11U6 %� s
ESTIMATED PROJECT COST: ARCHITECT/ENGINEER:
WATER FRONT? DESCRIPTION: PANEL # FLOOD ZONE:
BULKHEAD? DISTANCE?
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #):
DTE: /_/_
PERMIT #:
TOWN SEPTIC RECEIPT: Y or N SEPTIC CERTIFICATION:
Y or N
_
NEW YORK STATE DEC: PRE -DEC 9/1/75 YES or NO
DTE:
PERMIT #:
SOUTHOLD TOWN TRUJ_g 'EES: YES or NO
DTE_ /_/_
PERMIT #:
TOWN ZONING BOARD APPROVAL: YES or NO
DTE:/
PERMIT #:
TOWN PLAN. BOARD APPROVAL: YES or NO
DTE_ /_/_
PERMIT #:
TOWN HISTORICAL PRE (SPLIA): YES or NO
TOTAL
TOTAL:
NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): YES or NO
NOTES:
44
FEE STRUCTURE: FOUNDATION:
SF
FIRST FLOOR:
SF
SECOND FLOOR:
SF
OTHER:
SF
Il\TIT OTHER
TOTAL
TOTAL:
SF
FEE FEE
FEE
1. _SF)- ( SF)=
SFX $
=$
+$ +$ _
$
2.( SF)- ( SF)=
SFX $
=$
+$ +$ _
$
3.( SF)- ( SF)=
SFX $
=$
+$ +$ _
$
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:
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 DEAD: Y/N SNOW: Y/N SEISMIC: Y/N WIND: Y/N
WINDOW A DOOR SCHEDULE:
MISSLE TEST REQUIREMENTS: Y/N
EGRESS 5.7 S.F.: Y/N
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 CALLS: Y/N
TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE)