HomeMy WebLinkAbout31251-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32230 Date: 03/08/07
THIS CERTIFIES that the building ADDITION
Location of Property: 1255 GOOSE CREEK LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 8 Lot 9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 29, 2005 pursuant to which
Building Permit No. 31251-Z dated JULY 5, 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 WITH PERGOLA ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to STEPHEN MILGRIM & SUSAN HELLERER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
J(uthorized Signature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802 -
ce-0- to
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 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
It 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 huilding$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
New Construction: Old or Pre-existing Building: (check one)
Location of Properly: � tv JJpr' Cleeaax_
--- - - - -
House No. Street Hamlet
Owner or Owners of Property: Oji C�r/L�/ 2t tC-e.1t2!r yq
Suffolk County Tax Map No 1000, Section Block lot
Subdivision FiledMap. LnL
Permit No. __3(Z5 / _Date ofPermit. _ Applicant:
Health Dept. Approval: /J / Underwriters Approval: IA-
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ ZS,
Applicant Signature
Qom. �l�y3
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. 31251 Z Date JULY 5, 2005
Permission is hereby granted to:
STEPHEN MILGRIM
PO BOX 1696
SOUTHOLD,NY 11971
for
CONSTRUCTION OF A DECK WITH PERGOLA ADDITION TO AN EXISTING
SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at 1255 GOOSE CREEK LA SOUTHOLD
County Tax Map No. 473889 Section 078 Block 0008 Lot No. 009
pursuant to application dated JUNE 29, 2005 and approved by the
Building Inspector to expire on JANUARY 5 , 2007 .
Fee $ 150 . 00
Authorized Signature
Signature
ORIGINAL
Rev. 5/8/02
i
,AR _ 9
JAMES J. DEERKOSKI, P.E.
260 Deer Drive
Mattituck,N.Y. 11952
(631) 298-7116
Date: March 7, 2007
To: Town of Southold Building Dept.
Foundation Footing Inspection
Stephen Milgram
1255 Goose Creek La.
Southold,NY 11971
Permit# 31251
To Whom It May Concern:
A Footing inspection was preformed at the above-mentioned Deck, and it is deemed that
the footings were excavated to the proper depth and size and installed as per plan and
meet all state and local building codes. Any other questions please call.
DFc9' O
�O
Sincerely
LW
W.W
James J. Deerkoski
s
}aoF souTyo�
31a-sl z y
u
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ]
FRAMING / STRAPPING FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: " O
DATE 3 �l�b 7 INSPECTOR ✓G' //' -` �
It
OF SO&%
emm
f
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] �UNDATION 2ND [ ] INSULATION
FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ q]�FIRE RESISTANT PENETRATION
REMARKS: aa �++ /" .
`
LK-1 �--
DATE INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
ro
FOUNDATION (1ST) .
H
----------------------- ----- -----
(
FOUNDATION 2ND)
z
v�
ROUGH FRAMING&
PLUMBING _
INSULATION PER N.Y. — --- - - -- y
STATE ENERGY CODE
3- 1-o o
FINAL
ADDITIONAL COMMENTS
1
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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 4 sets of Building Plans
TEL: (631) 765-1802 planning Boar pproval
FAX: (631) 765-9502 S
www. northfork.net/Southold/ PERMIT NO. ��J Check
eptiS� c N— n
N.Y.S.DT.C.
Trustees
Examined ,20 Contact:
Approved 20 Mail to:9'T_p}%Fj�4 Mkt.L% t p l
Disapproved a/c TQT 1rs91.t SOUMeL.D� N`( 1,A-1 I
Phone: (oS1-165—I.Z8S
Expiration ,20
Building Inspector
LN
929 L_ i APPLICATION FOR BUILDING PERMIT
j
Date Z`� 20 OS
r vvr ` 1 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.
(Signa o plicant or name, if a corporation)
'{b6C91c 11.11. 5oyT%au%N1 WV7\
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises qTEpHEIJ NwA\yjM � SUSA1.1
(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:
1255 V- 0T'1AoL
House Number Street y wa na►oN
c4lteon did.oil
Count Tax Ma No. 1000 Section sk1w m bsili a°%
Y P '1� Block eAc 81 tueW eetw 3 m
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_5IN4t-e
b. Intended use and occupancy 51N4x-E FAtA%N.'t 'REe.%br T kl-
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost NOT IWoy1'1J AM T>t1S-n Fee # ISO r _
(To be paid on filing this application)
5. If dwelling, number of dwelling units_ i Number of dwelling units on each floor
If garage, number of cars )AX
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
/7. Dimensions of existing structures, if any: Front 55"►O`t Rear ZZz Depth
Height 20' Number of Stories ?-
Dimensions of same structure with alterations or additions: Front 55`10" 1Ir ZZ`
Depth LAS ' Height 2O Number of Stories Z 1"F
i
�3. Dimensions of entire new construction: Front %A' Rear 2`A ` Depth $ _
Height Zo1 Number of Stories Z
Size of lot: Front '75` Rear -]5 Depth 25C> `
10. Date of Purchase 11 IVb/?,000 Name of Former Owner K\� `itycFllA ►-'(NNS _
^11. Zone or use district in which premises are situated AC' _
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO-X.-
13.
OS13. Will lot be re-graded? YES_NO_)�__Will excess fill be removed from premises? YES NO
14. Names of Owner of premises ePITIVC I K%LkAtAAddress?CS 1(At. soorvWLCPhone No. 631-"1`S-6Z K _
NameofArchitect 'PEi m%( L-urMrrdr Address rl0.ir►tat. 4R4PfPhoneNo LA-111-0&400
Name of Contractor Vwrr Y-iJPWt1 Address Phone No.
. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO K
* 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 of 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNITY OF,5"iIU
vie-v-) N - W I G rt rV"A being duly swom, deposes and says that (s)he is the applicant
(Name of individual signing c6ntr ct) above Clamed,
(S)He is the ' W ne-�Y'
(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 i
- 4A day of SAkAji e, 20 06
044,,&� Z/ *'�V
N tary Public -W..m
S/11n;p4 of Applicant
NMIIy �
:.�
Applicant/
Owners Native:,. �J Revie��red: _
ArchitecU Qate:
Cagirteer:. ✓ _-- Submitted: f
SCTM #: `
Dislrim 400 Sectio((: (flock: Lot: . __
ProjectSubdivision `
Location: :( Name:
$iqk&, separate Required
cemfieation: (Yes f No) _
( � 9•
Zotaiq 1)151r1e1: �{N 11,01 size: jU. Actual: (I of cuveragc priied•7
Rcq. /
Req. Por
(C=roat l'�rd Pro(wscd: j (Side Yard Proposed: ® ( (Rear Yard Proposcd•
Project Description: ._
gui Q.UTR)tD EO—R BT VIUW N.A. `i4_ YES dumber
Suffolk County Health-Dept.
Naw York State. D, E. C.
Town Tirt sees .
Town Zoning Board approval:
Town-PN wing Board approval:
Flood.Plane Llevation???
Flood Zone:
NN�A�■�� ,, aa � 4
t�G L AQUEBOGUE ABSTRACT Corp. SITUATED AT
pR PSP AMERICAS WHOLESALE LENDER BAY VIEW
q." MICHAEL LYNNE
t , CYNTHIA LYNNE TOWN OF SOUTHOLD
11 ' SUFFOLK COUNTY, NEW YO{
S.C. TAX No. 1000-78-08-0
SCALE 1" =20'
MARCH 30, 1994
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TO THIS SUR ALTERATION OR ADOMON
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.COPIES OF THIS SURVEY MAP NOT BEARING \`NKED SEAL OR \ WALK 0e'�O� / y 04'E
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SFX SKILL THE LAND SURVEYOR'S INOT BE CONSIDERED \S'� d'�� 5���J��
JO.BE A VALID TRUE COPY. DRIVEWAY-/ �' �(.� ]NO WOOD TIE
OLMANTEE.S INDICATED HEREON SHALL RUN 147-W �` 1
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ONLY TO THE PERSON FOR WHOM THE SURVEY ,f p
t5 PREPARED, AND ON HIS BEHALF TO THE 10E0 WOOD STEPS
TRIS COMPANY, OOVERNMENTA AGENCY AND I O f I a
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TO TN[ INSTITUTION LISTED HEREON, AND oo WL� I I
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Joseph A . Ingegno
42
Land Surveyor
FENCE p3W�' CONT MON
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CONC.FOUND MON' ,�
° T7fle Survsye — Subdivisions — Site Plans — Constr„�ction Loyout FENCE GI's- 0/F
NE (516)727ACHER
—2090 Fax (516)722-5093 S HA WINSS HUMACHER
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Dare PREPARED IN ACCORDANCE WITH THE MINIMUM
S9 P.O. Box 1931 THE EXISTANCE OF RIGHT OF WAYS STANDARDS FOR TTTLE SURVEYS AS ESNAMMED
eW York 11931 Riverhead, New York 11901 AND/OR EASEMENTS OF RECORD, IF BY THE I-IAL.S. AND APPROVED AND ADOPTED.
-L ANY, NOT SHOWN ARE NOT GUARANTEED. � SUCH � IN � � YORK STATE LAND,
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- - _. _ --- OCCUPANCY OR
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768-1802 8'AM:.TO,APM FOR THE
FOL4'0WING INSPECTIONS:
yy/ 1. FOUNDATION -TWO REflUIREO
_ FOR POURED CONCRETE '
2. ROUGH - FRAMING 4 P MBING
. 3. INSULATION
4.,FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O. ` -
- - ALL CONSTRUCTIONSHALL MEET THE .-
'" REQUIREMENTS OF THE CODES OF NEW
- YORK STATE. NOT, RESPONSIBLE FOR cwt
"DESIGN OR CONSTRUCTION ERRORS. _ -
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