HomeMy WebLinkAbout29463-Z 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. 29463 Z Date JUNE 6, 2003
Permission is hereby granted to : Np ,1b - NoT� T
WILLIAM T CHILDS 1
1780 PECONIC BAY BLVD
LAUREL,NY 11948
for
CONSTRUCTION OF A HEATED, NON-HABITABLE, ACCESSORY 3 CAR GARAGE W/
ATTIC/STORAGE AS APPLIED FOR PER ZBA. THIS PERMIT REPLACES VOID PERMIT #22365Z
at premises located at 1780 GREAT PECONIC BAY BLVD LAUREL
County Tax Map No. 473889 Section 145 Block 0004 Lot No. 002 . 001
pursuant to application dated APRIL 10 , 2003 and approved by the
Building Inspector to expire on DECEMBER 6 , 2004 .
Fee $ 511 .20
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Auth rized Signature
ORIGINAL
Rev. 5/8/02
FIELD INSPECTION REPORT DATE COMMENTS
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STATE ENERGY CODE
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ADDITIONAL COMIIZENTS
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TOWN OE SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 l�/ Survey
www. northfork.net/S uthold/ PERMIT NOc--7?> g ( b Check
Septic Form
N.Y.S.D.E.C.
Examined 203 Trustees
Contact:
Approved 120 � ail to:
Disapproved a/c
r
Phone:
Expiration ,20
ui di pector
Z APPLICATION FOR BUILDING PERMIT
I
020 Date_. /�o� , 20,
INSTRTj CTIONS
?a. hislication MUST be completely filled in�X ty�writer or in ink and submitted to the Building Inspector with 3
sets of plans, accurate plot plan tb scab.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,if a corporation)
(Mailing address of applicant)
State whether applicant is(!n , lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
29 Al Ale
Name of owner of premises X61 4-7 011/1 (��l ZV5
(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:
!/W
House Number Street Hamlet
1
County Tax Map No. 1000 Section -f`o Block_ v Lot J
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 D2'e Al- 14 A2
b. Intended use and occupancy. GiQ'p— A G P d S r o re.4 Cs e-
3. Nature of work(check which applicable): New Building ✓ Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost 4019 Fee
(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 7-3
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front / e Rear Depth
Height Number of Stories
f �
Dimensions of me structure with alteratio or dditions: Front �� Rear �
Depth Height .2� Number of Stories
8. Dimensions of entire new construction: Front : ifar Depth �b
Height Number of Stories I
f / �
9. Size of lot: Front 1 41 o Rear /1�6) Depth 66
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 l�
13. Will lot be re-graded? YES '✓ NO Will excess fill be removed from premises? YES NO
14. Names of Owner of premises #bli-it/�1� &&dress IlWo 4 e-, A Phone No.
Name of Architect S4 AWA./ -Z e�/zAAddress 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 V
* 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 )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(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 thi
0202 day ofp.0 --:k
All
44'
NotaryPublic Signature of Applicant
ELIZABETH A STATHIS
NOTARY PUBLIC,State of New York
No.01 ST6008173,Suffolk ty
Term Expires June 8,20
PECONIC BAY BOULEVARD
N 69'13'00"E 191.00'
CONCRETE RETAINING WALL LOT 1/ LOT 2
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ENDIL 35A
CONC. FRAME
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6 05 W �R,s� L FENCE GEN'LY ON LINE EL 7.5 m W e o 00 �
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NAIL 37.74'
GUARANTEES INDICATED HERE ON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
TIRE COMPANY, GOVERNMENTAL AGENCY,
LENDING INSTITUTION, IF LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTITU770N.
GUARANTEES ARE NOT TRANSFERABLE TO
ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. NOTES: ALL ELVA TIONS SHOWN ARE IN 1929 NGVD.
UNAUTHORIZED ALTERA77ON OR ADDITION TO THIS
SURVEY IS A VIOLATION of SECTION 7209 OF FLOOD ZONE LINES ARE FROM FIRM PANEL
THE NEW YORK STATE EDUCATION LAW. 483 OF 1026, MAP NUMBER 36103C483 G,
EFFECTIVE OA TE MAY 4, 1998,
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYORS EMBOSSED SEAL SHALL
NOT BE CONSIDERED TO BE A VALID TRUE
COPY. SURVEYED: 2 FEBRUARY 1991
RE-SURVEYED: 20 MAY 2003
SCALE 1"= 30'
AREA = 30,038.50 S.F. (UPLAND)
OR
0.689 ACRES
SURVEY OF
LOTS 1 ,2, & P/0 LOT 3
MAP OF PROPERTY OF ELIZABETH MESROBIAN
AND FOREST HILLS IMPROVEMENT COMPANY, INC.
SITUATE
LAUREL, TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
SURVEYED FOR: WILLIAM T. CHILDS
HELEN H. CHILDS
TM# 1000-145-04-002.1
SURVEYED BY
STANLEY J. ISAKSEN, JR.
P.O. BOX 294
NEW SUFFOLK. N.Y. 11956
631 — 34-5835
GUARANTEED TO:
WILLIAM T. CHILDS
HELEN H. CHILDS
FIRST AMIERICAN TITLE INSURANCE CO. CENS D LA D SU EYOR
NYS Li No. 492 91 R449
BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: /03
APPLICANT: (A)& ,,o, � raja,� ,' Q_�2., DATE SUBMITTED: / /22/03
SCTM#
DISTRICT: 1,000, SECTION: /-� , BLOCK: "' � , LOT: SUBDIVISION: 141AOW `
ADDRESS: l7k6 CITY: ZONING DISTRICT: CONFORMING?Ay'd
BUILDING PERMITS OPEN_
/EXPIRED:
B -Z/C/0 Z�, INFO /BP -Z/C/0 Z- , INFO
BP2 -Z/C/0 Z- , INFO (-
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PRE C O N - BP -Z/ c/o Z- ,
SINGLE & SEPARATE CERTIFICATION-REQUIREDy 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:31jg5 REQ. LOT COV. ft.702 ACT. LOT �V. �y
REQ. FRONT a PROP. FRONT / REQ SIDE s ACT. SIDE
REQ. REAR 7 PROP. REAR / RR EQ HEIGHT PROP. H�IGHT
PROJECT DESCRIPTION: Ce ,..
1C
ESTIMATED PROJECT COST:A 59 r_R HT R'_"Y/ENGINEER: `Frw p&,t�� FAST TRACK__
WATER FRONT? DESCRIPTION: e&_
PANEL #: FLOOD ZONE: COMPLIANCE:
TAPPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DEPT: YES or BED #): DTE: _/_/_ PERMIT#:
T N SEPTIC RECEIPT: Y orev
,NT oW YORK STATE DEC: PRE-DEC 9/1/7 r 1 (�
SOUTHOLD TOWN TRUSTEES: E or N
TOWN ZONING BOARD APPROVAL E
TOWN PLAN. BOARD APPROVAL: YE jpo
W
TOWN HISTORICAL PRE (SPLIA): YES or
NEW YORK STATE CODE COMPLIANCE (S PAG ):;YES or NO
NOTES: it nee4s DE APPRON
Ak
N
1 V
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
_44 30
1. ( a ( SF)- (_ SF)= SFX +$ :tn +$ = $
2. SF)- Fbo SF)= MSF X $ .`3f}=$ +$ _+$ = 0`72
3. ( SF)- SF)= SF X $ =$ +$ +$ = $
FINAL TOTAL: $
NEW YORK STATE CODE COMPLIANCE CHECKLIST
USE/OCCUPANCY CLASSIFICATION: Z Sr
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION:
DESIGN CRITERIA: ENGINEERED/ FRIP WloomCtrl
mmompow—
FULL FRAMING DESIGN ELEMENTS:
HEADERS�/N WALL STUDS:$/N
GIRDERS: &INCEILING JOISTS:
FLOOR JO TS:�Y/N ROOF RAFTERS:
LUMBER SPECIES AND GRADE ff/N
DESIGN LOAD CALCULATIONS: Y/N
SHOULD INCLUDE LIVE,DEAD,SNOW,SEISMIC AND WIND(INCLUDING UPLIFT AND EXPOSURE)
WINDOW AND DOOR SCHEDULE:
MISSLE TEST REQUIREMENTS: Y/N
EGRESS, LIGHT, VENT: Y/N
LOAD PATHS
ROOF TO FOUN ON
NAILING/CONSTRUCTION SCHEDULE(9/N
MEANS OF EGRESS: Y/N I✓/*o
PLUMBING RISER DIAGRAM: Y/N
LOCATION OF FIRE PROTECTION EQUIPMENT: yq PIA-
TRUSS DESIGN: Y 4)
CERTIFICATION: IVpr
ENERGY CALCSON 13
TOTAL COMPLIENCE? Y/N(RETURN TO PAGE ONE)