HomeMy WebLinkAbout33676-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
11I0: Z-33186
Date: 08/04/08
TIllS CERTIFIES that the building ADDITION/ATLERATIONS
Location of Property: 210 FIFTH
(HOUSE NO.)
County Tax Map 11I0. 473889 Section 126
ST
(STREET)
Block 7
LAUREL
(HAMLET)
Lot 4
Subdivision
Filed Map 11I0.
Lot 11Io.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
FEBRUARY 6, 2008 pursuant to which
Building Permit 11Io. 33676-Z
dated
FEBRUARY 8, 2008
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 KITCHEN ALTERATION AND DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to RUTHANNE & GEORGE T WOODHULL
(OWNER)
of the aforesaid building.
SUFl'OLK COUlIITY DEPAR'l'MBIIIT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE lIIO.
8271
06/02/08
PLUMBERS CERTIFICATIOlII DATED
07/25/08 MATTITUCK PLUMBING
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Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
4
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APPLICATION FOR CERTIFICATE OF OCCUPANd:v
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 Dep!. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Swom statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lead.
5. Conunercial 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 bnildings 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
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swinuning 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, Conunercial $15.00
Date. ~h ~ I b(cPC/[f
.
New Construction:
Old or Pre-existing Building:
J>(
(check one)
Location of Property: ; / t1
House No.
;=;~JlI 77t
Street
I__"u'( g L
Hamlet
Owner or Owners of Property: I( tlT/(A.#N6' f- 6EtlJ16e 7:
Suffolk County Tax Map No 1000, Section /:26 Block
WIA7/J/ltftL
&7 Lot
c:t:;7'
Subdivision
;;/7510$
Filed Map.
Lot:
Permit No. 33b76
Date of Penn it.
Applicant:
17".i#"w'</~ waJ#'A'#~t
Health Dep!. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
Temporary Certificate
Final Certificate:
x
(check one)
Fee Submitted: $
(l) 0 .-c '33 I '6(0
Q.;v l'--jlb,
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Applicant Signature
Nassau Suffolk Electrical Inspections,Inc.
P.O. Box 549, Aquebogue, New York + 11931
Tel: 631-591-3097 Fax: 631-591-3098
Application: 8271 Date: 6/2/08
Issued to: Woodbull
Address: 5'h St Introduced By: Modern Electric East
Village: Laurel License #: 4253-E
Residential IBl Commercial
The following was examined and approved up to the above date and found to
be in compliance with the NEe:
Attic 1st Floor IBl 2"d Floor 3'd Floor Garage Conversion
Basement Hot Tub Addition Detached Garage Pool
S\\'itchcs Receptacle Fixtures G.F.1. Range Hood Dimmers
"-
10 9 I-Ceiling.II-LY 3 I 2-IIOY-4-LY
Sub Panel Dishwasher Wine Cooler Wanning Draw Oven Range/Amps Wine Cooler
1-IOOA I I I I I
Furnace Oil Gas Heat Zones Whirlpool Bell Transfonners
I Final Insp. I Meter Amps Phase Motors
I 6/2/08 I
Kitchen Renovation
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This certificate must not be altered in any manner
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Fax (631) 765-9502
Telephone (631) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: ; J ;;ISJO &
,
Building Permit No. 3g" 7~
Owner (;.xJCd A uJ J
(Please print)
Plumber:
MA1J;ITUCK PLUMBING
If8~&tYlJfaf~ Road
PO Box 1429
.' Mattituck, NY 11952
I celiify thj;M~llcdggll p~ 6111W8L;\tt3Q;upply system contains less than 2/1 0 of 1%
lead.
___p~ W J.~
(Plu~~ Signature)
Ar .,p
Sworn to before me this g{:;;
202L
~
DENISE KING
Notary Public, State of New Yorl<
Registration #01KI6041757
Qualified in Suffolk County
My Commission Expires May 15, 2
NC'~YP"bli~~CC"'Y
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.
8, 2008
33676 Z
Date FEBRUARY
permission is hereby granted to:
RUTHANNE WOODHULL
PO BOX 971
MATTITUCK,NY 11952
for :
CONSTRUCTION OF A DECK ADDITION & KITCHEN ALTERATION TO AN
EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at
210 FIFTH ST
LAUREL
County Tax Map No. 473889 Section 126
Block 0007
Lot No. 004
pursuant to application dated FEBRUARY
6, 2008 and approved by the
Building Inspector to expire on AUGUST
8, 2009.
Fee $
200.00
~ili
I Authorized Signature
ORIGINAL
Rev. 5/8/02
J3'7b z
TOWN OF SOUTH OLD BUilDING DEPT.
765.1802
INSPECTION
REMARKS:
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[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
DATE 7-" - 0 'is'
[ ] ROUGH PLBG.
[ ] INSULATION
~ FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
INSPECTOR ~~
3'3b1b Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS: ~
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[ ] ROUGH PLBG.
[ ] INSULATION
0f FINAL
[ ] FIRE SAFETY INSPEcnON
[ ] FIRE RESISTANT PENETRAnON
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DATE
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INSPECTOR ~ ~
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Date: June 5, 2008
]AMES]. DEERKOSKI, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-7116
To: Town of Southold Building Dept.
Re: StrappinWFraminW Footing Inspections
Woodhull
210 Fifth St.
Laurel, NY
Permit# 33676
To Whom It May Concern:
This letter certifies that all wind strapping on the above mentioned project is in tact, and
meets all state and local building codes. A FramingI Footing Inspection was also
Performed on this Structure, and all framing and footings were done correctly and also
meets all state and local building codes. Any questions please feel free to call.
FIELD INSPECTION REPORT DATE I COMMENTS ~""
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FOUNDATION (1ST) '- ~~
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FOUNDATION (2ND) a:~
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INSULATION PERN. Y. -- +to
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STATE ENERGY CODE
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FINAL 0
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ADDITIONAL COMMENTS ~
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Town
of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY lOCATION; S.C.T.M. #:
lece ~~.QQ..:/...
District Section Block lot
THE FOLLOWING ACTIONS MAY REQUIRE TNE SUBMISSION OF A
STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application)
Yes
No
1
----------------------------------------------------
2
3
4
5
6
7
8
9
Will this Project Retain All Stann-Water Run-Off Generated by a Two (2") Inch Rainfall on Site?
(This item 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.)
Does the SIte Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFlowl
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?
Will this ApplicatIon Require land Disturbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Surface?
Is there a Natural Water Course Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach?
Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off
into and/or in the direction of a Town right-of.way?
Will this Project 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 will NOT Include the Installation of Driveway Aprons.)
Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse?
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NOTE: If Any Answer to Questions One through Nine 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!
EXEMPTION:
Yes
l!!!
Does this project meet the minimum standards for classification as an Agricultural Project?
Note: If You Answered Yes to this Question, a Storm.Water, Grading, Drainage & Erosion Control Plan Is NOT Requlredl
~
srATE ~~~~';;N~~~~:................. 55
That I, ....~.,...\:~:}~...................,........... being duly sworn, de.poses and says that he/she is the applicant for Pennit,
(Name of individual signing Document) / \ r-;.---'"
And that he/she is the ........................................~...........................................................................................
(Owner, Contractor, Agent, Corporate Officer, elc,)
Owner and/or representative of the Owner of Ov\'ner's, 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 III ner set ford1 in the application filed here",th.
Sworn to before me this;
..........Ex.Y...........,............... day OfrJ' ..
Notary P~bl~~~f.y\.I..~::...... .... ....LYNOA'....BOHN.
... .....,2oe..i..i
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(Signature of Applicant)
FORM - 06/07
NO. 01806020932, Suflol~_GclunI1
Term expire. Mwoo 8, ~
LOT 38 LOT 39 LOT 40
"'" N 69'l.3'10"E 1.Q2.. 7 L "'"
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" LOT 49 LOT 48 LOT 47 "'.
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WOOD FRAME RESIDENCE UJ
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S 69'1.3 10 W 165.0
TIE=l o'
FI FTH STREET J/I
SURVEY OF
LOTS 47,48,49, INCLUSIVE
IN
SUBOIVION MAP SECTION ONE
OF PROPERTY OF
GEORGE I, TUTHILL & OTHERS
SITUATE
LAUREL, TOWN OF SOUTH OLD
SUFFOLK COUNTY, N.Y.
SURVEYED FOR: G. THOMAS WOODHULL
RUTHANNE WOODHULL
FM# 861
DATE FILED JAN 15, 1929
TM# 1000-126-07-004
GUARANTEED TO:
G. THOMAS WOODHULL
RUTHANNE WOOOHULL
SURVEYED: 17 JANUARY 2008
SCALE 1"= 20'
AREA = 24.582 SF
OR
0.564 ACRES
GUARANTrES INDICA rED HERE ON SHALL RUN
ONt Y TO THE PERSON FOR WHOM THE SURVEY
1$ PREPARED, AND ON HIS BEHALF TO THE
nnE COMPANY, GOVERNMENrAL AGENCY,
LENDING INsnrunON, IF LlSTF:D HEREON, ANO
TO THE ASSIGNEES OF THE LENDING INSnTUTJON.
GUARANTfES ARE NOT rRANSFERABLE TO
ADOJnONAL INSTIWnoNS OR SUBSEQUENT OWNERS
SURVEYED BY
STANLEY J. ISAKSEN, JR.
P.O. BOX 294
NEW SU FOLK. N.Y.
631-7 -5835
08R1654
UNAUTHORIZED ALTERATJON OR ADDmON TO THIS
SURV!:Y IS A \I1OLA nON OF s~cnON 7209 OF
n-f[NEW YORK STATE mUCAnON LAW.
COPIES OF THIS SURvtY MAP NOT BEARING
THE LAND SURVEYORS EMBOSSED SEAL SHALL
NOT BE CONSIDERED TO BE A VALID TRuE
COPY.
PERMIT NO.
'J,-::"1c7(,e:-
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning B?jlTd approval
Survey ,/
Check.dl 7.,:27
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Storm-Water Assessment Form_
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SouthoIdTown.NorthFork.net
Examined
eJ.../ r: 20121..
/
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Contact:
Mail to:
Approved
Disapproved alc
Expiration
8/& ,2rDf-
Phone:7~ 5.. Cf;? / '1
ff~.
, Building Inspector
u L:-.~-o o-.J:.J\O
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TQl^.J: (;" ::~_..,.~-,:'J("~2--.t
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 oflot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and waterways.
I 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.
APPLICA nON 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.
/J c:/__._
(Signature of applicant or name, if a corporation)
~c~ C;;~ ~ J;:~~
(Mailing address of applicant) A/. K
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
21~
Name of owner of premises
Builders License No. 2K'; '7 S z.. -h"'"
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
~ , 0 Sii, 0+1(> d
House Number Street
L A.ure I
Hamlet
County Tax Map No. 1000 Section I d. b
Subdivision
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\"'FfI\e~ Map No.
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Lot 00 y
Lot
2. State existing use and occupancy of premo ses and intended use and occupancy of proposed construction:
a. Existing use and occupancy I c.. \
b. Intended use and occupancy~i' rt reJIO l!o..:110() IAJ WW 0 \AWe decJ..
3. Nature of work (check which applicable): New Building Addition /' Alteration /
Repair Removal Demolition Other Work
4. Estimated Cost ,f Z ~ ~. ...0 Fee ~ d. HJ. IJ'-1}
, (To be paid on filing this application)
5. If dwelling, number of dwelling units ~Number of dwelling units on each floor~ 0..
If garage, number of cars 1'\ \ (l
\
(Description)
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. " 10
7. Dimensions of existing structures, if any: Front
{\\~eight Number of Stories
Rear
Depth
\0..... Dimensions of same structure with alterations or additions: Front
I\'t Depth Height Number of Stories
8 D' ' f' ~ F R "'.., ,
. lmenSlOns 0 entIre new constructIOn: ront ear -' -:i Ir
~eight ,-/~ 0'/ Number of Stories
Rear
..,
I ..
Depth t.:. ~
/
, I
Rear -'4 :r Depth / r;.-c
Name of Former Owner _F=u I Ie ("
9. Size oflot: Front
/~~
10. Date of Purchase
I ~.:J ?l
II. 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 ofpremisesWno dl\l.t \ \ Address~honeNo. h31-;;..qf~ qlrJ....
Name of Architect Address Phone No
Name of Contractor Z~n ~.rr Addres~S G~./ ..c..d'honeNo. 7~S'- ?...?/y
S'" ~U''"''M''P. ,
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.e. 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.
18. Are there any covenants and restrictions with respect to this property? * YES_ NO~
* IF YES, PROVIDE A COPY.
(S)He is the
STATE OF NEW YORK)
,. dd fJ/S,S:
CO~'[~~F~
~ \~l..) o",,}: being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
Qd'~'~
(Contractor, Agent, Corporate Officer, etc,)
of said owner or owners, and is du1y 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.
Sw~~o before me thi
, " ('day of
....~ 1)(\
J':f ml-~
'-.../ Notary Public
20cl
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S"",,,,,, of Appli='
LYNDA M BOHN
NOTAFI't PUBLIC, State of New'iu/II
NO. 01806020932, Suffolk County
Term Expires March 8, 2011.-
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All dimensions ~size designations given are
subject to verification onjob site and
adjustment to fit job conditions.
Woodhull
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Designed: 1/4/2008
Printed: 2/5/2008
This is an original design and must not be
released or copied unless applicable fee
has been paid or job order placed.