HomeMy WebLinkAbout31002-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31301 Date: 11/28/05
THIS CERTIFIES that the building ADDITIONS
Location of Property: 480 TOPSAIL LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 79 Block 7 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 10, 2005 pursuant to which
Building Permit No. 31002-Z dated MARCH 15, 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 & CARPORT ADDITIONS TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to JOHN W REARDON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
thorized Signature
Rev. 1/81
Form No.6
• TOWN OF SOUTHOLD
BUILDING DEPARTMENT pj
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY 1 - '
2 �
This application must be filled in by typewriter or ink and submitted to the Building Department with the foll2owing:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines, streets, Aud-urm'sual 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
I. 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. Qo\1
New Construction: Old or Pre-existing Building: 1/ (check one)
Location of Property: l ?�)CD
House No. Street 11 Hamlet
Owner or Owners of Property: __� cel ) \.&.)
—7
Suffolk County Tax Map No 1000, Section / ` Block 7 Lot �J
Subdivision Filed Map. Lot:
Permit No. _j I U Z Date of Permit. 3-16 —0 `J Applicant: 97i
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (ceck one)
Fee Submitted: $
Applicant Signature
(!R,.ex,- G4 333
c o--;Z3)301
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. 31002 Z Date MARCH 15, 2005
Permission is hereby granted to:
JOHN W REARDON
SOUTHOLD,NY 11971
for
AS BUILT DECK ADDITION & AS BUILT CARPORT ADDITION AS APPLIED FOR
ADDITIONAL CERTIFICATIONS MAY BE REQUIRED.
at premises located at 480 TOPSAIL LA SOUTHOLD
County Tax Map No. 473889 Section 079 Block 0007 Lot No. 015
pursuant to application dated MARCH 10 , 2005 and approved by the
Building Inspector to expire on SEPTEMBER 15, 2006 .
Fee $ 300 . 00
X,
t ori d Signature
ORIGINAL
Rev. 5/8/02
oF souryo6
-31 0 0 Z,
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ]
FRAMING / STRAPPING [FINAL A
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE / �� INSPECTOR Jam'
FIELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION(1ST)
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-------------------------------------
FOUNDATION
-----------------------------------
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PLUMBING
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INSULATION PER N.Y. 3
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING►DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 w 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
www. northfork.net/Southold/ PERMIT NO. ,Check ',bo_
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 4 20 % Contact;
Approved j 11
20 7 Mail to:.512. (-Rc ur ST
Disapproved,a/c
�� ivy 1144 y
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Phone: '17 2-05-,Z
7
Expiration ,20
4
a )<f6TION FOR BUILDING PERMIT
r
Date 2005
r� INSTRUCTIONS
a. This application MU 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 pertnit 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,housincode,and re lations, and to admit
authorized inspectors on premises and in building for necessary inspections.
�. i
17 - (Signature of applicant or name,if a corporation)
:5/;Z. rRov 5rC,i t,uPo n i/1/16(Mailing address of applicant
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
c)
Name of owner of premises -::So4ts_� W i�E?°riZ1�C�L)
(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:
'tab O SR1L L(n, JO SHOD
House Number Street Hamlet
County Tax Map No. 1000 Section -79
I Block 7 Lot
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 SI mL",F 174wvL
b. Intended use and occupancy SAVkiG:-
3. Nature of work (check which applicable): New Building Addition dC' L Alteration
Repair Removal Demolition Other ork
(Description)
4. Estimated Cost � , b�-O Fee
—T (To be paid on filing thi application)
A-
5. If dwelling, number of dwelling units tJ Number of dwelling units on each floor AU
If garage, number of cars A)1A
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. VIA
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 Rear 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 NO ✓/
13. Will lot be re-graded? YES NO V Will excess fill be removed from premises? YES_NO off
14. Names of Owner of premises SL OAU Address Phone No.
Name of Architect Address Phone 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 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 OF 5�f F.I k )
1 -FqR-7�SOA-) being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the (5LON 6s'---
(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 N st 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
) 0 {~ drayofD Mt- < k n20 of
otary Public Signature of Applicant
John M.Judge
NOTARY PUBLIC state of New York
Ivo.ojJusoss466
ouali!ied In Suffolk County
commission Expires May .20 02
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ALL CONSTRUCTION SHALL rfl c a5'
MEET THE REQUIREMENTS OF THE
CODES OF NEW YORKZTATE_;
j I ! ► FLOOD ZONE z� y ►,"�
COMPLY WITH CHA T R" 6"
I 'O f 8-4
FLOOD DAMAGE PREVENTION
SOUTHOLD TOWN CODE. f VST
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NEW YORK STATE & TOWN CODES
1 ( AS REQUIRED AND CONDITIONS OF
SO�T-110 TCWN ZBA
(OWN PLANNING BOARD
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FOLLOWING =�
1. FOUNDr+"I0USE IS UNLAWFUL
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2. - 'G WITHOUT CERTIFICATE
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3. INSULATION OF OCCUPANCY ti v. ;;Fury
4. FINAL • COiv_ pt'✓
BE COMPLETE ..r,_ THE
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BUILDING PERMIT EXAMINER CHECKLIST
DATE REVIEWED: / /04
APPLICANT: DATE SUBMITTED: _/_/04
or
SCTM#DISTRICT: 1,000, SECTION: , BLOCK: , LOT: /5— SUBDIVISION: 4,24
ADDRESS: CITY: ZONING DISTRICT: CONFORMING?
BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N
BP -Z/ C/0 Z- ,INFO /BP -Z/ C/0 Z- , INFO
BP -Z/ C/0 Z- ,INFO /BP -Z/C/0 Z- , INFO
SINGLE & SEPARATE CERTIFICATION-REQUIRED cl� 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 7/1/8
REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV.
REQ. FRONT ' PROP.FRONT REQ SIDE ACT. SIDE
REQ. REAR PROP. REAR REQ. HEIGHT PROP. HEIGHT
PROJECT DESCRIPTION:
ESTIMATED PROJECT COST: ARCHITECT/ENGINEER:
WATER FRONT? DESCRIPTION: PANEL, # FLOOD ZONE:
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED-#f- DTE: _/ /_ PERMIT#:
TOWN SEPTIC RECEIPT: Y or N
NEW YORK STATE DEC: PRF-DEC 9/1/75 YES or NO'J DTE: /_/_ PERMIT#:
SOUTHOLD TOWN TRUSTEES: YES�ofNO DTE /_/ PERMIT#:
TONY I-ZONING BOARD APPROVAL: YES or NO DTE: _/ IF�i2M
PIT#:
TO'l�NN PLAN. BOARD APPROVAL• S or NO DTE / / T'ERMIT#:
T n WN HISTORICAL PRE (SI�y S or NO
NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): YES or NO
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
1. ( SF)- ( SF)= SFX$ =$ +$ . +$ =$
2. ( SF)- ( SF)= SFX $ =$ +$ +$ =$
3. ( SF)- ( SF)= SF X $
FIAL TO
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: YIN
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:YIN
LIVE: Y/N DFS; Y/N SNOW: Y/N SEISMIC: Y/N WIND: Y/N
WINDOW AN�?yP
QOR SCHEDULE:
� .
MISSL EST PTQUIREMENTS: YIN l
EGRESS 5.7�.: YIN
LIGHT 8%:A. IN
VENT 4%: YIN
NAILING/CONSTRUCTION SCHEDULE: YIN
MEANS OF EGRESS: Y/N
PLUMBING RISER DIAGRAM: YIN
LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N
TRUSS DESIGN: YIN
CERTIFICATION: YIN
ENERGY CALCS: Y/N
TOTAL COMPLIENCE? YIN (RETURN TO PAGE ONE)
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