HomeMy WebLinkAbout33098-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 10/22/07
No: Z-32684
THIS CERTIFIES that the building
ADDITIONS
Location of Property: 9350 NORTH
(HOUSE NO.)
County Tax Map No. 473889 Section 79
BAYVIEW RD
(STREET)
Block 8
SOUTHOLD
(HAMLET)
Lot 12.3
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
MAY 21, 2007 pursuant to which
Building Permit No. 33098-Z
dated
JUNE 1, 2007
was issued, and conforms to all of the requirements of the applicahle
provisions of the law. The occupancy for which this certificate is issued
is SCREENED PORCH & WOOD DECK ADDITION TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to DAVID DICKERSON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMEI!IT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
118529C
10/05/07
PLUMBERS CERTIFICATION DATED
N/A
ignature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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 from plumber certifying that the solder used in system contains less than 2/10 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.
New Construction:
~
Old or Pre-existing Building:
( check one)
;::;t>.~old
Hamlet
Location of Property: Q,5S' 0
House No.
PJOI2TH f?,wv~..... J ~
Street
Owner or Owners of Property: "bt.... u;. ~.. r. ~,r>.
Suffolk County Tax Map No 1000, Section
Subdivision
()7 q
Block
O()O~
Lot ()/2. 1)03
Filed Map.
Lot:
Permit No. '3? "Q ~ 2-
Health Dept. Approval:
Planning Board Approval:
Date of Permit. 0:.-x I 1.vc J Applicant: Ihfrj ~ \ 2lJtn
Underwriters Approval:
Request for:
Temporary Certificate
Final Certificate:
v--
(check one)
Fee Submitted: $
'6i'~
~Iicant Signature
~73JB5
C. O--? 3!J(P S lj
,
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.
33098 Z
Date JUNE
1, 2007
permission is hereby granted to:
DAVID DICKERSON
9350 NORTH BAYVIEW RD
SOUTHOLD,NY 11971
for :
CONSTRUCTION OF A SCREENED PORCH & DECK ADDITION TO AN EXISTING
SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at
9350 NORTH BAYVIEW RD
SOUTHOLD
County Tax Map No. 473889 Section 079
Block 0008
Lot No. 012.003
pursuant to application dated MAY 21, 2007 and approved by the
Building Inspector to expire on DECEMBER 1, 2008.
Fee $
200.00
~~
! Authorized Signature
ORIGINAL
Rev. 5/8/02
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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OWNER STREET 9220 VILLAGE SUB. LOT
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TYPE OF BLD,
odh 6u\ '-I illf IN ~:SS6C. PROP,ftLASS Jf!rK
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LAND ( IMP. TOTAL DATE
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FRONTAGE ON WATER TILLABLE ' .- .,.-,/ ,.,
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FRONTAGE ON ROAD WOODLAND
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DEPTH MEADOWLAND
BULKHEAD HOUSE/LOT l~tl,c:) ,
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L._u . _.__._. L ._._ TOTAL . ,'-'
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79-8-12.3 02/02
~.~;w
'1 X Z - 1-6
3~O
-) iYO
.:).
Patio
Deck
)( ).-
14 X 110 -: 2-'2-'-/ > %4
_ z 0
'g 'Jr..
31>0
~{V.2'~ -::;;-
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O.B.
Pool
hi I 11/
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I '16 P- m. I Q +l-
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01,,., ., 12.5 YV I I+t:. Sf Y
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15 .. ..,.
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Foundation PC Bath 1'7- Dinette
Basement Floors Kit.
Ext. Walls Interior Finish LA.
Fi re Place Heat
Wood stove
Dormer
Attic
Rooms 1st Floor
Driveway Rooms 2nd Floor
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
[ ] ROUGH PLBG.
[ ] I~LATION
[ ~INAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
aJ
REMARKS:
~
DATE
INSPECTOR
Id
,
3?>0'r'lZ-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
~.w..IN~ STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT ON
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
FIRE RESISTANT PENETRAnON
~~
~t: Lu... .
DATE "8'-;7--07
INSPECTOR ~~ ~
3309?t;
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] .!9"NDATION 2ND [ ] INSULATION
IYf FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSlRUC11ON [ ] FIRE ~ANT PENETRAnON
REMARKS 'e- r-c/~ ~;M
C' -
DATE
INSPECTOR
- ------ -
3301l 'Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
C1 FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIREPLACE & CHIMNEY [
[ ] RRE RESISTANT CONSTRUC'nON [
~
REMARKS:
D
~
DATE
~
7-0-01
] ROUGH PLBG.
] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
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FIELD INSPECTION REPORT DATE I
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FOUNDATION (2ND)
ROUGH FRAMING &
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INSULATIONPERN. Y. ----
STATE ENERGY CODE
FINAL
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COMMENTS
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ADDITIONAL COMMENTS
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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 F onn
N.Y.S.D.E.C.
Trustees
Contact:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SouthoIdJ
PERMIT NO. -0 3D 11 t/
I'/; ,2<F '1
(/?jr ,20 D7
Examined
Approved
Disapproved ale
12-/ I
I
Mailto:Ch"dp c:;Th"rnn ~
PO. 50)' 1311} Ir.mt>c:pa--r
Phone:(""3I-7'dZl-'1Qq ~ f 1'147
Expiration
,20 cg
p~
Building Inspector
~\i\( '2. \
1 . APPLICATION FOR BUILDING PERMIT
...-..'--
..~
Date M f"l )' I lot- I
,2007
\
I 'i -
a. ...ksap~i~ation 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 oflot 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 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.
INSTRUCTIONS
r-h()rle5 M. Th,.,VVlr,<; Arrh..tf'r1-
(Signature of applicant or De, if a corporation)
Po. PH)";. 9/7. '"G""p~ttrr N111CJ<+7
(Mailing address of plicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
CLp.p.I,('nn+ I'<=; o..rrWLc,j-
,
Name ofownerofprernises 1)0.\11 d C .J)IC \I, erson ~ kQrt"n'.J:~tH.:~~ V ...,
(As on the tax roll or latest deed) I .
If applicant is a corporation, signature of duly authorized officer
.
" .
'_,.J'
.
. .
. .
(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 proposeq work will be done:
-3~ ')0 No~:;':h BAY\'/lelAl RlYJrl.
House Number Street
j Sc.ut-hotel ~ N '/
Ham et
County Tax Map No. 1000 Section
Subdivision
'7Cj
Block f3
Filed Map No.
101"'12...11
Lot
"
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy U es I AI" ,,+"0 I 11\1\/ e ~
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Additio
Other Work
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(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.
I
I"n ,_ ai' n /I
7. Dimensions of existing structures, if any: Front~ Rear , -I - 18
Height 12 ,/ 'L'" Number of Stories ,
Depth
110 '- 0
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: Front I 0/.1- ~
I
Rear
Depth
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated f2 e. '" I nt"'"., -j-. f'A I
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO_
13. Will lot be re-graded? YES _ NO_Will excess fill be removed from premises? YES_NO_
Oo.,;'''C. PICI<US,,", .
14. Names of Owner of premises l/,r.,.....~ NI".-rL\ 1 AddressCf:>'I1nNOf"+1.. R...)Mr...Bhone No.
Name of Architect ll-, nd p c. -rh,., ...../1 <: Address Rnc 8--,.-" Tame<fod'hone No Co?, 1- 7:J.1- 7C/ q.3
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet ofatidal 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~lli~
~"' ~being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the ~rh.~t-
(contracto~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. ;1
I
t
20 JL:::t-
MnAN1~ ll!llllllll(l
NOTARY PUBLlCbState of New '1tl*
No.01D 4634870 '
Qualified in Suffolk County
Commission Expires September 3O..l.DJ b
06--04-2087 12:18
SOUTrlCLO 8UILDING DEPT :531765'J502
33oq~
PAGEt
1'7- ~ ~/d,3
Erosion, Sedimentation and Storm-water Run-off Control Plan ASSESSMENT FORM
Yes
No
/
EXEMPTIONS:
A, Does this project meet tle mlnHl\Unl standards 101' classiflf;C1tion as an Agncultural Project. _
Nota: If YOIIlnswtrtd V.. to any of Ih. abew., a Storm-water, G,adlng, Dralnaga & E,oolon Control Plan i. not required.
----------_____'R____.._
...~-----~-----_._------------_....__._--------_._--
i\CTION~JtEomR1NG THF. SI'RM1SSION OF A STORM- WA TER, GRAD11'1G. ])RAINAGl: ill EROSION
(;ONTROL PLAN CERTIFIED BY ,\ DESI!,,!'! PROFESSJOI'AL.lN THE STATE or NEW YORK,
Item Number: (A Check Mark (J) ft:'l" eac.h qu\~~t.i(m l~ n.:q\lln;'d fUT (ompll..~l.\' ~~-pphc.(.tilm)
1.
Will thi,;: project rttam all St~;rtTi~W;ltel' l{un.<dfgenenned on SHe?
Obis will iuclude- an I1ln-ci"!"f created hy ,<;;jte clearing dud/or {~onstrl1ctjon activities ilS 'vell as all
Site Improvemems and the. pCllllancm rrc<.!.twn i)[ imp;;rv:ous eur[acts,)
y..
~
2.
Will thIs ilroJf':ot require any land filling. grading 01 excayation where there is tI ch<lnge to the
natural existing grade mvolYing 111'.11e them 200 cubic yards ofmalerial within any pan:"!"
/
Q~
B/
8;
g/
[;]y
GJ-
Nole: If any answer to questions ono through eight is anlwtl'.d with a check mark I. thl Box, a Storm-wat.r, Grading,
Dral"ag~ II Erotion Control PiM io required and mu.t be $ubmitted for review prior to issuance of any building parmit.
3.
Will this, Jpplicatwn require land dislurbir.~ activttje~: encompa..;;dng an area
of five tJ-10U$3nd (.~,OO{)) ~qLlJ.re feet ofgrnund !\urface: or more?
.-------------------------------------.,-----------------------------
4.
T", there a Nalur"l.[ WUlt:T L'l)UT."t: rUflTllng thf{mgh the site or IS this pro.lee! within
One hundred (100) tee,t (It wetlands OI" bt~ach'!
STAlE 01' Nm, YURK,,, f.Lfl /,
COUNTY Ol"~u. n 17"-J\,....
Tbal' JolA (l~o. ',,-
.. . ss
bfliug duly sW~nn. deposes i\l'.d says that he/sh(" is tb~ nppltt'lUll fur Pennil
Sworn to be'fore me this;
5~fTh'V"i .-J \J 't\.e..".,.... '. .. 200"1
NotaiYPII"U,,: .~.f:.~~~
5.
WlH there be s.ire p:epanHion on Sk'pl.,::~ Whl:;;h c,;x(,c:t:d nf:.etn (15) fe-tet ()fv~rliral fist' h)
One hundred (100) ftel t'.f}~Ol'j7.()ntal dio;tance?
6.
Will dri\:cway:s. pa.rklng arca., Dr I1lheT impervious sUli"aces direct Stonn-\Vater Run'off
into andlor in the dlTt'.(,tion of a 1'o\'m Right~of..Way?
r>WIi."T, ,r,r:rri\C10r, A~t'n;, (:Ofl)\ll;;i~ O/fkn, -de)
OWlli.'r and':or rq")lot'ntJ.ti\!t; (); the OWTII.;,l (.lr (lwm'T'~, and L'l. dub flurh::;t,i7cn to perfomlf:)l" hilve pel'fonued the stJid work and to mak::
Ilud file this ltJ:plic.ancn. that ali ';!.a:{"!Tlt:nl~ ulf1!.amd Ii! ~hi$ Appl.i.l..',H!U1\ ,.tI'e fl1le to the besl of his ~Jl(lwled~t <)Ild bdkr; and thalth{'
Wllrk sill b~ p~lf(lnned rn lhe n:"ltl.!H~f set f',llth In the- "ppJil'&t1on ti;cd hl,.;f(.''OVll.h.
"
,
Will this apphcilHon requiri.~ the p:m;~mc[it o[rn.a1.crial, removai ofvegetattOM and/or the-
constructIQU of any i1em withm the Town Right-,)f..W.lY (,1T w:Jd shoa!:k1" ;:,ten')
. (This ,tem doas not inciude thalnstallation of dri..way apron..)
8.
Viill there be site prepm;)liol1 wItbin tlle ont; hUJldH~'d (j()O) year t1()~)dplaitl of allY w9tf'tC()t)r~<,:?
(Name c-f /Il<:Jivi"kui ~11;h1lil; O<,"AllIli'i.l)
And thou He/Shf;" ~l-> tL:
Aj,,,",,J
~d~ "
.... .. q'V . .....('-Y'-. ...
(Slgna!l~rc (,f Appll(;ilut)
LINDA P. RANDOLPH
NOTARY PI8JC. -.Of,.._
No. 01RM1_
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