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HomeMy WebLinkAbout31475-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold. N.Y. CERTIFICATE OF OCCUPANCY No: Z-32120 THIS CERTIFIES that the building ADDITION Date: 01/08/07 Location of Property: 2973 LIGHT HOUSE RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 50 Block 3 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 22, 2005 pursuant to which Building Permit No. 31475-Z dated SEPTEMBER 28, 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 DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to NIJOLE KUDIRKA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A u orized Signature Form No. 6 TOWN OF SOUTHOLD i BUILDING DEPARTME TOWN HALL `�Ty -im 8 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 tram 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 )ate.t b New Construction: Old or Pre-existing Building: (check one t_ Location of Property: rf 3 House No. v Street Hamlet Owner or Owners of Pro pert I Y-�j 1 0 Suffolk County Tai Map No 1000, Section_f� _t� Block — 3 —� 0 Lot Subdivision----------------__ �� Filed Map, -------Lot:_ _ c Permit No, 319 1 ���Date of Pernut. Applicant�� 4{/0 C�- Health Dept. Approval: Undenvriters Approval: Planning Board Approval: Request for: Temporary Certificate _ Final Certificate: V (check one) Fee Submitted: $ c Applicant Signature cod 3af� 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. 31475 Z Date SEPTEMBER 28, 2005 Permission is hereby granted to: NIJOLE KUDIRKA 195 2ND AVE NEW YORK,NY 10003 for : DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 2973 LIGHT HOUSE RD SOUTHOLD County Tax Map No. 473889 Section 050 Block 0003 Lot No. 010 pursuant to application dated SEPTEMBER 22, 2005 and approved by the Building Inspector to expire on MARCH 28, 2007. Fee $ 150.00 -ized Siqnature ORIGINAL Rev. 5/8/02 3 � 7s� TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 1 SPECTION [ OUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/ STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY[ ] FIRE SAFETY INSPECTION DATE c0 / INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 NSPECTION FOUNDATION IST [ ] ROUGH PLBG- ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ REMARKS: ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION DATE -/C)/;- - INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND( ] IN TION [ ] FRAMING/ STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 L 2 TEL: (631) 765-1802 1— FAX: (631) 765-9502 L-12 _ _ 12 j www. northfork.net/.Southold/ PERMIT NO:"-"31y77-6z- Examined/�Zv- '20 Approved 164f,20 Disapproved a/c BUILDING PERMIT APPLICATION CHECKLIST Expiration Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Septic N.Y.S Contact: Mail Phone: 7 % Building Inspector APPLICATION FOR BUILDING PERMIT Date 7 Z 7 120 6.5 -- INSTRUCTIONS SINSTRUCTIONS 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. Signature of applicant or name, orporation) !J•a . QoX %7P_ �i evL-c)o,�7F Illy (Mailing address of applic t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Qe," i'rc,/ C ot 7Y 4 r - Name of owner of premises `� (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. 3 r 2(n©— H Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: House Number �-/ Street County Tax Map No. 1000 Section D Subdivision (Name) Filed Map N Hamlet 3 ­- Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy t- CC b. Intended use and occupancy v � 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 4. Estimated Cost Fee ,if /moo (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. 17 ' z.6 -r 7. Dimensions of existing structures, if any: Front ' r ( Rear 461�eL& Y Depth 4,5 Height 24 Number of Stories 2_ Dimensions of same structure with alterations or additions: Front Rear Depth_ S211 Height 24 r Number of Stories 2� 8. Dimensions of entire new construction: Front /'I ¢ i( Rear. Depth Aft 7 t.0 ec Height Number of Stories 9. Size of lot: Front / 5"I' Rear ___/ Depth 7'7� 10. Date of Purchase4ZZY 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 --Z 13. Will lot be re -graded? YES_ NO Will excess fill be removed from premises? YES NO 14. Names of Owner of premises v " Address Phone No. Name of Architect /1 • a -,q-- Address Phone No 7/t�70 �- e s99 Name of Contracto u o Address /w, do A, 4 7d° Phone No. 477 —/ 70 d= Gre.sy�d, # 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 ) -�J—v 1! a ko ' rev i Ac�z being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contractor, Agent, Corporate Officer, 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 2U day of 20_e2 ] Notary P blic LINDA J COOPER NOTARY PUBLIC, State of New York NO. 01 C04822583, Suffolk Go Term Expires December 31, 202 y� L.J Signature of Applicant rl TOWN OF SOUTHOLD OOPERTY RECORD CARD OWNER STREET 2 3 VILLAGE DISTRICT SUB. LOT FORMER OWNER N E ACREAGE S �y W (Y TYPE OF BUILDING 2 ?f RES. S VL. FARM COMM. I IND. CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS OD ,2 / o G R, CA? ceiwe Me ai 7s 6 o U 3 o a o 3 4 o/ 2, 0--e 1,er j/rs/firs' F3i B/ sa��� ✓c. 1a.e�� f 4 ��s Ec, c 4--- ----- 0i0- IT AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK tillable, 3 Noodland swampland 3rushland -iouse Plot notal M. Bldg' /GGo X3 sv G. �73� Foundation Bath Extension Basement Floors Extension Ext. Walls Interior Finish i Extension Fire Place Heat S -o ' U Porch Roof Type too Porch Rooms 1st Floor Br .. X21, %�F 1=- 3-341 atio Rooms 2nd Floor Garage _ ,tD .�G c a _ fl/ Dn eway V3490'. Dormer o.B. 8�8 !r� sv 3.2-` 3 ¢ 907. R_ SURYEYEU F'ae r CN ��,- � / HOL-0 L Eat 5 5UFFcx-&-, CbJt rY, N i form. Daverr�or-f) d N.4800'6. •• ------ hed�:mw m.. 4 I ti n 9 elect. 1 !right loO.o Dist. laoo, sect. osc�, l3�oc�.3. Lo -r I o r ®a HtOflt.NttBnt n, iron :57 E_4:N i i Tf . VVCF WX --- e-- naayrrrow. _ , 5.49'53"3Q" !45.94 ALC3l - �furn. fr. -25h"f O' . `house �'Tf pi 0 =Do Sava S A VIOLATION W ` i'O O icor or nr Naw _wa a... WWMM ,AW. !right loO.o Dist. laoo, sect. osc�, l3�oc�.3. Lo -r I o r ®a HtOflt.NttBnt n, iron :57 E_4:N i i Tf . VVCF WX --- e-- naayrrrow. _ , 5.49'53"3Q" !45.94 ALC3l - �furn. A 5 . Maned AaYN1AM w-�w»� �'Tf pi 7908-01Z17 =Do Sava S A VIOLATION W ` icor or nr Naw _wa a... WWMM ,AW. t Gu #o #re ovvtmt ie FHe MEoAiL CHrcac�a!'_ In,'AJrO * Goand sQaTer'ir uaaaawoa1 Uivdl savitxyz Ban! VALM nMCOM �,.. as lNvy 7,1979. rala�TlO Mrro.I aIAL. +�,. ro Te T950N ,oe vnLOM TILT �. u AtrA�. Afo Lxf Ma erLAL: ro re QOL)E-r"jr--&: 1 4N -MYL PC. 7SIi GOMPAW. GOVSHMEWAL AGSK• tool" 06TWO M us,ro MaeoM PNM SPAMOM Aa MDT DATGM To jam"M MAI elmwMrwe n a�w. Licerrsed•t a/ttd uMYs' ALL CONSTRUCTION SHALL GGT THE REQUIREMENTS OF THE S OF NEW YORK STATE. fit if r d i i- I ✓r? t2" 9� cotJG, P1r=r<S -ro w" C27M:LaW GrIZG,Pr-- $3 CI, NU Jt •ol.t v 'Roto sti�oaE IZAB's@I16''o•G j fl�- Coll 11 :r-Ac� C-xltT t;vtr N o u S� ZKS f-'�1NM!r.1G^ a ,unYIrlllT-4- il �.- ;111' �7 ro� e�lr3 tC T, v 71arte . J • • • Yti f�"{� APPROVED AS NOTED DATE: B.P. # 3/y FEE: �� a BY: NOTIFY BUILDING = 4RTMENT AT 765.1802 8 AM TO ; PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - `dVl REQUIRED FOR POURED C; "-RETE 2. ROUGH - FRAk ; & PLUMBING PA . J , 11F - 1I„TION MUST --cow au:r-,w c W K REQUIRLI.' =NTS OF THE CODES OF NEW YORK STATE, NOT RESPONSIBLE FOR -1N o�€�>y W� Lf�`Y�R�TdQW ff9RarR� S � �otsT i1:ihLGsCrs+S SaaL.L. r3C S 1 M Gro ra It S -t rill o"& -c 1 a GcaNNI'_G-Tc�r� St` MOR nto. 4u L8, %s GA. or+, Atr�rwmov- � 15c� u^L OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY 0wrtcr-� : N}Kur>trxrxa 20%1%S )-l/r1kTNouSG 1y,17. gouTH NOLO t,3-/ t''g-11 p&r� GHt rt?GT, _ Aor miar-l-t•.,oN T05A,.7ln 3 o 0 SA, ST71 ST.; Gu T>A1E = SCP q X1-0 soA�-G�� r•a�--r �'� ovY�1�F1 �F T ST Ptt , BUILDING PERMIT EXAMINER CHECKLIST DATE REVIEWED: 'LlIE/w APPLICANT: ������ �� - DATE SUBMITTED: SCTM# DISTRICT: 1,000, SECTION:y , BLOCK: 3 , LOT: SUBDIVISION: 14' ADDRESS: ITY. ZONING DISTRICT: CONFORMING? =' BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP310-?0 -Z / C/0 Z- o pe.,, , 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.1997100-25. Merger.(A nonconforming at any time after 7/1/8 REQ. LOT SIZE: 4t ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV. REQ. FRONT qO PROP. FRONT RE([DE `Q /< -,_5f SIDE REQ.REAR 52) PROP. REAR REQ. HEIGHT PROP. HEIGHT PROJECT DESCRIPTION: ESTIMATED PROJECT COS I ARCHITECT/ENGINEER 2n j« WATERFRONT? /r6 DESCRIPTION: PANEL # FLOOD ZONE: BULKHEAD? DISTANCE? APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES q TOWN SEPTIC RECEIPT: Y4rr_NAEPTIC CE NEW YORK STATE DEC: PxE-DEC 9/1/75 YES or SOUTHOLD TOWN TRU'"I'EES: YES of TOWN ZONING BOARD APPROVAL: YES o TOWN PLAN. BOARD APPROVAL: YES or TOWN HISTORICAL PRE (SPLIA): YES or #): DTE: PERMIT #: _/_/_ 'ION: Y qf N ` t PERMIT #: DTE_ _/ /_ PERMIT #: DTE: PERMIT #: DTE: / / PERMIT #: NEW YORK STATE CODE COMPLIANCE (SEE PAGE 24k'ES)or NO NOTES: 44 FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INTT TOTAL: SF FEE SF)- (—_SF)= SFX $ =$ +$ 2. (_SF)- (__SF)= SFX $ =$ 3.( __SF)- SF)= SFX $ =$ OTHER TOTAL FEE FEE FINAL TOTAL: $ / �5-0 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 CEILING JOISTS: Y/N FLOOR JOISTS: 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 WINDOW AND 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 o� PLUMBING RISER DIAGRAM: Y/N LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N TRUSS DESIGN: Y/N GIRDERS: Y/N ROOF RAFTERS: Y/N WIND: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? YIN (RETURN TO PAGE ONE)