HomeMy WebLinkAbout33025-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-32671 Date: 10/15/07
THIS CERTIFIES that the building ADDITION
(STREET)
Block 1
SOUTHOLD
(HAMLET)
Location of Property: 61341 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 56
Lot 4.3
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in tbis office dated
MAY 3, 2007 pursuant to which
Building Permit No. 33025-Z
dated
MAY 10, 2007
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 ADDITION & ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to MICHAEL P & CLAIRE L GLEW
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPAR'nmNT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
07-6368
10/03/07
PLUMBERS CERTIFICATION DATED
09/28/07 CUTCHOGUE EAST PLUMBING
Rev. 1/81
.
.---'""1
.
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
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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:
I. 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 2/1 0 of I % 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:
I. 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.
\0
~cJ 7
New Construction:
K
Co I 3'-+ I -R 0 uA-e L '5:
House No.
l...;[Ol(L & M (C!iJtRJ
Suffolk County Tax Map No 1 ection S-0 Block (
Subdivision , 10 1Jt.cI;> I cl( N ! ~~ - - Filed Map. q ! C( C; Lot. _~
Permit No. -.33()J.. s---__ Date of Pen nit. ~ 711J107 APplicantld ,CJ...a.t / tf CIa }/(J G/P{/l)
f /
Underwriters Approval'
Old or Pre-existing Building:
(check one)
So (-CillD Id
Hamlet
Location of Property:
Street
Owner or Owners of Property:
{J-;fpvJ
Lot
if. 3
Health Dept. Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate:
~
(check one)
Fee Submitted: $
CI~~&fif~)
~;/3257
C'o t-~~ 7(
r
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.
33025 Z
Date MAY
10, 2007
permission is hereby granted to:
MICHAEL P & CLAIRE L GLEW
PO BOX 1950
SOUTHOLD,NY 11971
for :
ADDITION & ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at
61341 MAIN RD
SOUTHOLD
County Tax Map No. 473889 Section 056
Block 0001
Lot No. 004.003
pursuant to application dated MAY 3, 2007 and approved by the
Building Inspector to expire on NOVEMBER 10, 2008.
Fee $
338.40
.~CJL
I Authorized Signature
ORIGINAL
Rev. 5/8/02
',0~-@-~J,U 91
'i~i ',,28~W'
I' L-,,_~
t,LU , [)EP~
l__T("'~s~r5~'!THO~_D
-.-.-}
T ow~ Hall, 53095 Malfl Road
POBox \179
Sou'hold, New Yolk ~ '971
Fax (5\6) 765-1fn
T el9pholle (516) 765.1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLO
C E R T I FIe A T ION
DATE: 7/2 '3 / 0 7
{ (
Owner:
fJ1~ {Ie - C Ia..~.r~
(please print)
33025
GleeJ
Building Permit No.
Plumber: -::I6:C~ G\<;H,({J,..J"
(please print)
cute Ljve E
f- H t '-c
I certify that the solder used in the water supply sys!;em
contains less than 2/10 of 1\ lead.
ilUIAN J, NAGY
NNotary Public S,.,. of New Yor~
0.4896735
?uaIKi<:d In Suffolk County
omrrW'~.~l('ln Fxoires May 20JL.
Sworn to before
01
--.-f.t2. day of
Notary Public,
.L -r9 ;;tIP?
County
33 cO 2 S--2:-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT ~UCTION
REMARKS:
[ ] ROUGH PLBG.
[ ] IN~ATION
[~NAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRAnON
DATE
/0/03 /07
5 /
INSPECTOR /
~
3502-Se--
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST [ ] R~H PLBG.
[ ] FOUNDATION 2ND [vrfNSULATION
[ ] FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUC'nON [ ] FIRE RESISTANT PENETRATION
~ ,-..L
REMARKS: 1.v~'OtC-.
DATE
INSPECTOR
3302-5" ~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECT
N
[ ] FOUNDATION 1ST [
[ ] F9""iDATION 2ND [ ] INSULATION
[ JlfRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAnON
REMARK~-5 ':;L ~C- dc-
DATE
INSPECTOR
}) 0 r-S :z-.
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
~ FRAMING (!rMPPI~ [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONSTRlJCnON [ ] FIRE RESISTANT PENETRATION
REMARKS:
/~*.~
DATE
{, - U -,() 7
INSPECTOR #.~
330K~
SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONS1RUC11ON [ ] FIRE RESISTANT PENETRA110N
REMARKS: ~{~ ~
(n ry~.
DATE
INSPECTOR
33 OJ.5 Z---
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
N. FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONSTRUCTION
REMARKS:
~
L6L
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT PENETRATION
~
DATE
, ~ 7~ 07
INSPECTOR ~ ~
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FIELD INSPECTION REPORT
FOUNDATION (1ST)
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COMMENTS
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FOUNDATION (2ND)
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PLUMBING
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INSULATION PER N. Y. --
STATE ENERGY CODE
FINAL
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southoldl
PERMIT NO.
330.;l!? e
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
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Sf
5/ to ,20-'2L
.41/0,20fl"l-
Examined
Approved
Disapproved ale
Mail to:
Expiration
11/10, 20~
"
Phone:
t~
J Building Inspector
APPLICATION FOR BUILDING PERMIT
Date
,20_
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 ofthis 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
issue~ a Certificate of Occupancy.
. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
i~suance 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 South old, 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 owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
P it (l JC(((E' L
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
U lc&aJ
~(evJ
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
~.
I. Location of land on w
lot'?
House Number
o~{d
County Tax Ma~ 1000 Section
Subdivision .J1. J t 1
(Name)
" '\':!')~ 1AcrW: Hamlet
;,' ,', " ,'F',' 11"-
S Co BlQCk, .. (
. . .~.. . ~. ..i.Y!t8iiMap..N o.
Lot eft '3
Lot
2. State existing use and occupancy of premises and ijl!,end~~~~e f~ o~cupancy of proppsed construction:
a. Existing use and occupancy \ ~ ~ '{PSi ('~
b. Intended use and occupancy ) .fZl ~ {' f' S t ~
/
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
Alteration
4. Estimated Cost
tip 75, (){ro
I
(Description)
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
J
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
S0
I
Rear
50
Depth
,)t,.,
Dimensions of same structure with alterations or additions: Front 7 3
Depth Height Number of Stories
Rear 7 3
/
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
10. Date of Purchase
2. ~()
/9%9
Rear
2-z..0
Depth
~7{)
:Janus f /(dllf
9. Size oflol: Front
Name of Former Owner
11. Zone or use district in which premises are situated
If - 'If ()
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO ~
.
13. Will lot be re-graded? YESL NO_Will excess kJ removed from premises? YES_NO X'
14. Names ofownerofpremis.cJalff<JJJ~ciddress PO 8tfX. /q5l)PhoneNo. 7&s-Co 1;17
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.
ST ATE OF NEW YORK)
COUNTY o~-I+o J~St
C lChrf' L.
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
0[ C' ()
(S)He is the
(j;~v
(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
3,0{ day of J1d1~ ' 20tlJ-
~. ~ ( ,
np. ({ y: IlliJ ~ -
" Nota Public
~ ~~1)
l<CNIALSt<! Signature of Applicant
UNDAc"SrATE OF ~.:'" r' '''''''''~
NOTARYPU~ 52-4624771 .'
OUA\.IFIED=~~~'WJfJ
CCllAlAlSS"" ·
1\000 -See - 1-4_3
OWNER
J. p.
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IMP.
LAND
--
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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f Woo
-flt1.-I~
be?/.:
STREET c;, 13
~4/i(1 Rd'
ACR.
.z ~ \'('"'(
TYPE OF BLD.
VILLAGE
DIST.
SUB. LOT ~
tV',," no ( SlA 6
5
S
REMARKS
PROP. C),f-SS
'Z--(V '::>
TOTAL DATE
\,.. n V:.,
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J\:.\'t <:;
FRONTAGE ON WATER
1.le @ <?OQ
TILLABLE
FRONTAGE ON ROAD
DEPTH
WOODLAND
MEADOWLAND
HOUSE/LOT J ,^c r:! ,12.00
TOTAL
BULKHEAD
I ~
3~ >'l I :'1 rv "/
,<
.
~.Bld9. 2-L/ X Sb =- /344 3. &<l 7032.- Foundation .@ Bath @ .7-3 Dinette
C.B.
=~!. /7 )( 32- -='- 54'-i . FUL I
E slOn 3.'. Basement ~WL Floors G/tR.P~ ; r--Kit.
SLAB
, 1/
Extension Ex!. Walls '70 Interior Finish L.R. f
E;xtension Fire Place /t.-<J v Heat ~ -!fir D.R. /
Patio Woodstove BR.(o""?l $''7
Porch Dormer ~ I
Deck Attic
Breezeway Rooms 1st Floor
Garage Driveway Rooms 2nd Floor
-
O,B. - -----.. Iff) Z; "7- I...-
Pool m I/I~ ~~ t:--- -/OGIi' -----
. 1--"50-h-L .. ~,
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ENERGY CODE CALCULATIONS
CHAPTER 5
SECTION 501
Detached One and Two Family
(For Non-Electric Heat)
For: !1Jd~.1 t c!rllr [lev
1'", . 1(.. I
'<;ol1li./) (1/'1 ,'n/
,
5750 Degree Days
Zone lIB
Per: d II J?c t jjJ
Design Criteria
SUBSYSTEM
AREA DESIGN CODE
"u'" "l]"
Exterior Walls S <I 'I
.
Ceiling Roof S' { 2..
O. 1/ 'i"/ 0.14
0.03 0.031
b.OJ 0.05
6.5
4.5
0.1
0.06
Floor Over Unheated Space .5" 12.
Heated Slab On Grade
Unheated Slab On Grade
Basement Wall
Crawl Space Wall
Dated: )1,e/~7
,
DESIGN CODE
UA UA
1:.5.2 u 16.16
~5.3{ 15 .1] 7
zS. h 0 2.5, to
/,ot../ I..
1/ 7 63
,
NOTES:
Construction shall comply with 502.1.1 moisture control and 502. 1.4 air leakage
Building Envelope Systems to meet requirements of Section 501
The mechanical systems and equipment including:
HV AC Eqnipment, HV AC Systems, Duct Systems, Ventilation Systems and Insulation of Piping Systems to meet
requirements of Section 503
Service Water Heating Systems & Equipment to meet requirements of Section 504
Electrical & Lighting Systems & Equipment to meet requirements of Section 505
To the best of my knowledge,
belief, & professional judgement,
these plans are in compliance
with,the code.
Erosion. Sedimentation and Storm-water Run-off Control Plan ASSESSMENT FORM
Yes No
EXEMPTIONS:
A. Does this project meet the minimum standards for classification as an Agricultural Project. X
.Note: If you answered Yes to any of the. above, a Storm-water, Grading, Drainage & Erosion Control Plan Is not required.
-------------------------------------------------------------------
ACTIONS REQUIRING THE. SUBMISSION OF A STORM-WATER. GRADING. DRAINAGE & EROSION
CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE. OF. NEW YORK.
Item Number: (A Check Mark (J) for each question is required for complete application)
1.
Will this project retain all Storm-Water Run-off generated on Site?
(This will include all run-off created by site clearing and/or construction activities as well as all
Site Improvements and the permanent creation of impervious surfaces.)
Yes
No
~g
(dj{
g~
GJ~
b]'rJ
gK
GJ~
(d~
Note: If any answer to. questions one through eight is answered with a check mark in the Box, a storm-water, Grading,
Drainage & Erosion Control Plan is required and must be submitted for review prior to issuance of any building permit.
2.
Will this. project require any land filling, grading or excavation where there is a change to the
natural existing grade involving more than 200 cubic yards of material within any parcel?
-------------------------------------------------------------------
3.
Will this application require land disturbing activities encompassing an area
of five thousand (5,000) square feet of ground surface or more?
(Name of individual signing Document)
... being duly swam, deposes and says that he/she is the applicant for Pennit,
:~:a:n:~~::::e:::tatlv~ oft~e' ~~~(i2~~:~~;:~: id~t~~~~;;::~f;~;~~L.~r. ~~;e' ~~r;o~~~ '~e ~~ld ~~rk' ~~d:O :ke
and file this application; that all statements contained in this application are true to the best of his knowledge and belier; and that the
work sill be performed in the manner set forth in the application filed herewith.
4.
Is there a Natural Water course running through the site or is this project within
One hundred (100) feet of wetlands or a beach?
5,
Will there be site preparation on slopes which exceed fifteen (15) feet of vertical rise to
One hundrl'd (100) feet of horizontal distance?
Sworn to before me this;
..,...3M......"daYOfm~..20~7 /l /. ~
Notary Public ~ Ad4EI(hA!dkl4'......lJNDAF.Kc:NIAU3~.ctkt........... . ..
Ur' ~OTAfl~flI.IIIlIC. STATE OF r'C"'" v--'((Signature of Applicant)
NO 52-4624771
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES NOV 30, 20J..Q
6.
Will driveways, parking areas or other impervious surfaces direct Storm-Water Run-off
into and/or in the direction ofa Town Right-of-Way?
7.
Will this application require the placement of material, removal of vegetation and/or the
.construction of any item within the Town Right-of-Way or road shoulder area?
(This Item does not Include the installation of driveway aprons.)
8,
Will there be site preparation within the one hundred (100) year floodplain of any watercourse?
STATE OF NEW YORK, "'0. f' /'. ~I/
/yOUNTY OF U -rTO'1
That I, C (q (r{> L. G few
ss
ENERGY CODE CALCULATIONS
CHAPTERS
SECTION 501
Detached One and Two Family
(For Non-Electric Heat)
For: !1,df,1 t Clcft. [lev
tv' . I!~, /
SOllli./d tJ'1 ,/n/
,
Design Criteria
5750 Degree Days
Zone lIB
Per: [/Ii Poc I. jJj
Dated: )II:J/~7
,
SUBSYSTEM AREA DESIGN CODE DESIGN CODE
"U" "j]" j]A VA
Exterior Walls S'f'f o. II 'i' 5' 0.14 ~5.2.u 16.ft
Ceiling Roof 5'12-. 0.03 0.031 t5.3C 15.1] 7
Floor Over Unheated Space 512.. (J.OJ 0.05 zS. b 0 tJ,to
Heated Slab On Grade 6.5
Unheated Slab On Grade 4.5
Basement Wall 0.1
Crawl Space Wall 0.06
JO~.I t, 1/ 7 63
s: ,
NOTE
Construction shall comply with 502.1.1 moisture control and 502.1.4 air leakage
Building Envelope Systems to meet requirements of Section 50 I
The mechanical systems and equipment including:
HV AC Equipment, HV AC Systems, Duct Systems, Ventilation Systems and Insulation of Piping Systems to meet
requirements of Section 503
Service Water Heating Systems & Equipment to meet requirements of Section 504
Electrical & Lighting Systems & Equipment to meet requirements of Section 505
To the best of my knowledge,
belief, & professional judgement,
these plans are in compliance
with.the code.
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