HomeMy WebLinkAbout34097-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEP~iqTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z 33351
Rte: 10/27/08
T~IS CERTIFIES that the building ALTERATION
Location of Prc~erty: 2590 WELLS RD
(HOUSE NO.) (STREET)
Co~nty T~x Map No. 473889 Section 86 Block 1
Subdivision
Filed ~ap NO. Lot No.
PECONIC
(HAMLET)
Lot 10.8
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 4, 2008 pursuant to which
Building Permit No. 34097 Z dated AUGUST 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 MINOR ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to EILEEN T MCGUIRE REVOC TRUST
(OWNER)
of the aforesaid building.
EI~t-rKICAL CERTIFICATE NO.
PLU~ CERTIFICATION DA'r~U
N/A
N/A
N/A
~rize~
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
inspector with the following: 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 fgrm).
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. Co~nercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Comp!lance from architect or engineer
responsible forthe building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
Ypre-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 amd a 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, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildinm - $i00.00
3. Copy of Certificate of Occupancy - ~ .~
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...~.. ...........
~ocation of property ..................... ...........................................
House NO. Street Hamlet
Onwer or Owners of Property .................... ! ...................................
Connty Map Mo lO00, Section..O.G. ......... Biock..f/ ........... Lot.fG.'.. ...............
Subdivision . .. Filed Map Lot ........
Permit No ................ pace Of Permit ....... Applicant..~..ZV..~..P.~.......9.~. .......
Health Dept. Approval...~~ .......... ...... ~ ~Unde~riters. Approval...~ .................
pla~ing Board Approval .... ~.......,.......
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: ~ ........................
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)
PEl~4IT NO. 34097 Z Date AUGUST 8, 2008
Permission is hereby granted to:
JOHN T MCLANE
2590 WELLS ROAD
PECONIC,NY
for :
MINOR ALTERATION TO AN ENTRANCE & MUDROOM OF A SINGLE FAMILY
DWELLING AS APPLIED FOR
at premises located at 2590 WELLS RD
County Tax Map No. 473889 Section 086 Block
pursuant to application dated AUGUST 4, 2008
Building Inspector to expire on FEBRUARY 8,
PECONIC
0001 Lot No. 010.008
and approved by the
2010.
Fee $ 200.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSULATION
[ ]FRAMING / STRAPPING ~,FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI~,' ~ATION
REMARKS: .~~~
DATE INSPECTOR
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
~FOUNDATION 1 ST [
] ROUGH PLBG.
[ ]INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
[ ] FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
[ ]FIRE RESISTANT CONSTRUCTION
REMARKS:
FIELD INSPECTION REPORT I DATE ~ CO~iM~l~
~S~ATION PER N. Y
STATE ENERGY CODE
'
q
~DITION~ COUNTS
7
~ o
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork. net
PERMIT NO.
/
Examined
,etI . Contact:
Approved E~, 20/~ Mail to:
/
Disapproved
Phone:
Expiration ,~/ ~)/, 20~'0
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
plarmmg Board approval
Survey_
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Storm-Water Assessment Form
Buil&ng Inspector
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS Date/~
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.
(Signature of applicant or nmne, if a corporation)
0,/iailing ~ddress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises ~-ot~/.J /~¢Za~ ~ol~ ~lLtg~J ~CGO/~,~
(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. At,,~ r~/~.~.-~_t~ 9~ ~'
Plumbers License No. " --
Electricians License No. "
Other Trade's License No. -
l. Location of land on which proposed work will be done:
House Number Street
County lax Map No. 1000 Section q~(o
Subdivision
Hamlet
Block I
Filed Map No.
Lot
State existing use and occupancy of premises and intended use and/occupangy of proposed 6on~trudtion:
a. Existing use and occupancy
Fee
b. Intended use and occupancy
Addition Alteration
Other Work
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost
,.
5. If dwelling, number of dwelling units
If garage, number of cars
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancT, specify, nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front '7 7.,5' Rear
Height ¢-~' Number of Stories
Dimensions of same structure with alterations .~r,~dditions: Front 7
Depth ~ 6 Height Number of Stories
8. Dimensions of entire new construction: Front Rear
Height Number of Stories
9. Size of lot: Front
10. Date of Purchase
.Depth
Rear
Depth
Rear /~3" Depth 4td'~ 'j' '~ ~--/~'~'/J
77.0~
~ o o ~ Name of Former Owner w'dz: ~ ,.o ,J
11. Zone or use district in which premises are situated
12. Does proposed construction violate an5' zoning law, ordinance or regulation'? YES NO
13. Will lot be re-graded? YES NO Will excess fill be removed from premises'? YES NO
14. Nines ofO~er ofpremses a~l~.t,fic&,e Address $oX~w ~
Phone No.
Nme of Contractor Address Phone No.
15 a. Is this prope~ wi~in 100 feet of a tid~ wetl~d or a freshwater wetl~d? *YES NO
* IF YES, SOUTHOLD TO~ TRUSTEES & DEC. PE~ITS MAY BE ~QUI~D.
b. Is ~is prope~ within 300 fe~ of a tid~ wetl~d? * YES~ NO
* IF YES, DEC PERMITS MAY BE ~QUI~D.
16. Provide survey, to scale, wi~ accurate fomdafion pl~ ~d dist~ces to prope~ lines.
17. If elevation at ~y point on prope~ is at 10 feet or below, must provide topographical data on s~.
lg. Are there ~y coven~ts ~d restrictions wi~ respect to this prope~? * YES~ NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
COUNTY OFt~,~,g. S)S:
O'~,~ ~&//--r/~. t3'?r'~l ~ being duly sworn, deposes and says that (s)he is me applic~t
~me of individual signing con~act) above named,
(S)He is ~e
(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~,
~77-4 day of fiO:; ~Sr' 20/' ~"
~~Bkm.~ork
":~u~ldied - Suffolk Goun~
~:?, ~%pires duly 31, ~/~
Signature of Applicant
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET ~¢ ~,~. VILLAGE DIST. SUB. LOT ~_..
FOYER OWNER N ~ { l ~ ~ ~ E ACR. J
RES. % ~ b S~S. VL ~ FARM CO~. CB. MICS. Mkt. Value
~ND IMP. TOTAL DATE R~RKS
Tilloble 1,04 7 ~' ~ FRONTAGE ON WATER
W~land ~0 ~ Z 4 FRONTAGE ON ROAD
M~d~d DEPTH
H~ PI~ I ~ ]~ ~ BULKH~D
86-1-10.8 2~04 N ~'
~xtension ~m/~xt~3'go~ ~tX~ ~ Raiment ~ Floors
xtension '~ ':~ X Ext. Walls ~ ~ ,nteriorFinish
xtension '~X~-~X~ ~Z¢+ J ~O, ~ FirePlace ~ Heat ~
orch ~'~ L~ ~ ~g %~ Attic
~ln J~Y t~ = L~ ~- ,~ ~ Patio Rooms 1~ Floor
re~eway ~;~ q ~ Driveway Rooms 2nd Floor
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S,C.T,M. #:
I Io,8
Dlslrlcl Section Block Lot
THE FOLLOWING ACTIONS MAY REQUIRE THE 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)
Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site?
(This item will include all mn-off created by site clearing and/or construction activities as well as all Site
Improvements and the permanent creation of impervious surfaces.)
2 Does the Site Plan and/or Survey Show All Proposed Drainage SIructures ndica ng Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFIow!
3 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 Matedal within any Parcel?
4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of r'~
Five Thousand (5,000) Square Feel of Ground Surface?
5 s here a Natural Water Course Running through the SRe? r~
is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a WoUand or Beach?
6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feel of Vertical Rise to ~
One Hundred (100') of Horizontal Dislance?
7 Will Driveways, Parking Areas or olher Impervious Surfaces be S~oped (o Direct Ston'q-Water Run Off ~
into and/or in the direction of a Town right-of-way?
8 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.)
9 Will this Project Require Site Preparation within the One Hundred (100) Year F oodplain of any Watercourse? r=~
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 Permitl
Y e~s N~o
EXEMPTION: Ye_._~s N~o
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 Required! -- --
STATE OF NEW YORK,
COUN~ OF....~....~..t~-ffro C (,-"~._._ SS (20NNI£D. BUNC~
Notary Public, State of ~ York
......................................... No. 01BU61850~0
,- qua!ifi~d n Suffoll~ (]l~nlv
{Name of individual signing Document)
And that be/she is the ....................................... ~-7.,~.'~g~.'.'.'~.ff-... ~-~/./...5 .......................................................
(Owner, Contractor, Agent, Corporate O'flcer, elc )
Owner and/or representalive of the Owner ( fOwners, and is duly authorized to perform op have perfoi']'ned the said work and to
make mtd file this application; that all statements contained in this application are b'ue to the best of bis knowledge and beliefi ;u~d
that the work will he perlbrmed in thc manner set forth in Ihe application liled herewith.
Sworn Io before me this;
.............. ~..~ ................... da5, of ~,._...~ ................. 2 .~..,.~
FORM - 06/07
SURVEY OF PROPERTY
51TUAT5: PEC, ONIC,
TOl,~h 5X::)U~LD
5U~=OLK ~Th',
SURVEYED 04 - Iq - 2000,
H.P. 04 - 26 - 01, 04-2D-02, 06-1~-02
~dd'l ~op_o 06-12-02,
FOUNDATION LO~ATION 06-16-0~
FINAL 0q-02-04
od
5b~=I:OLK C, OUNT"K TAX #
IO00-g~,-I-10.6
C, tERTIFIE~ TO:
John T.
EIl~n T.
Bonk of E~nl~h~o~ln
Oommon~eol~h Lond
TI~I~ In5uron¢¢ C. omponq
TI~,I¢ # W.H,DO00125-~ -
%
NOTE:5:
~TAKJ5
AREA = 8¢i,14q 5.F. or 2.0466 AORE
®F~APHIO SCALE 1"=50'
S66o43'52"W
462.07'
Lond No~ or FormerlU of
Jennie Lee Pierce
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 \\Compaqserver~lxOSL2000 pros~20-155
SYM
I FIBERGLASS
1 I t SWING
L -- ENTRY /2'-8" /
DOOR SCHEDULE
SE:E
HEIGHT THICK
R.O.
6'-8" 1-314"
MFG. BY C~TALOG;
REMARKS
FIBERGLASS,
LOW-E GLASS, TO
MATCH EXISTING -
' ELECTRICAL LEGEND
RECESSED INCANDESCENT UGHTJNG FIXTURE
HALO #H-5 WITH ft~Ol0W TRIM (H-149g-1951 WP) OR
~,PPROVED EQUAl.
NALL MOUNTED SWITCH "DECORA" ROCKER
STYLE OR DIMMER -SINGLE POLE, MULTI-WAY
OR OCCUPANCY SENSOR AS DIREC~:D BY OWNER
WALL MOUNTED 110V. DUPLEX RECEPTACLE
"DECORA" STYLE LOCAllONS AND MQ.UNTING
HEIGHTS TO BE CONFIRMED WITH OWNER
DEVICE TO BE WEATHERPROOF
I1
tl
II
L/
oSCUF,:,I~,~ ~ OR ALL CONSTRUCTION SHALL
MEET THE REQUIREMENTS OF THE
USE IS UNLAWFUL CODES OF NEW YORK STATE.
WITHOUT CERTIFICATE
OF OCCUPANCY
Ui~OERWRI~RSCERTIRCATE ELECTRICAL NOTES :
AP?..~AS NOTED
· . 1. All electrical work Is to be completed by a licensed electrician and Is to comply with all National. State & Local
n~TE' 0~/~//~' B.P.#~ oodeelnadditlontoUnderw'rlter,,tandmrdsa, theyapply. Elecbical work muxt be performed by mechanlcs
un, ,,.~ ~7 //[ skilled in their respective trade and Shell present appearance and function ~yplcal of best trade practices. W~2rk -
FEE' ~r/]'~ . ~Y: ~or materials not Installed in this manner will be repaired or replaced at no expense to the owner.
NO'~IF~ BUILDIU3 DEPARTMENT AT .
765-18a2 $ AM TO 4 PM FOR THE 2. All work shown on the drawings is diagrammatic. Ete~trical Contract_er shall coordinate hie w. ork with all other
trades. Do not scale drawings for fixture or deice locations. Vmify all fixture, outlet & equipment locations with
FOLLC,", lNG IN%~:ErT~?. B' Architect and/or Owner prior to commencing work.
1, FOUk!OATtON - T '~ REQUIRED
FC '~OURED C $,iE1 E 3, Electrical system is to provide adequate service and circuits fl~r all iml~osed_.loads and equipment ~s_required or
2. HOUGH - ~SAh',iN: & FLUMBING dbected by the Owner. ,,
· ~,~: ?-tc-~- ~ 3, INSULATION r ' 4, Provide "Decora" style swlt,:hes & r~ept~tes to match existing and Ground Fault proration circuit breakers or
REQUIREMENTS OF THE CODES OF N~ contractor as required.
YORK STATE. NOT RESPONSIBLE FOR
~pon completion of the work under his contracL Such eerU,flcate shall Indicate the apprbval of the
RETAIN STORM WATER RUNOF~ork Installed and of the complete at eetxlcat system,
PURSUANT TO CHAPTER 236
, .~ , t LEGEND
~XISTING WORK .. ~ ......
TO BE REMOVED ~ ......
- V '
/ , /'
NEW WORK TO _
BE INSTALLED
m m
ff~'A :~---FT'
_0c7 LJ-T' M
~,~~ / ~ . 1230 Traveler SI'reel Southold N.Y. 11971
~ .:5 ,
~, I,I , ,, .......
GENERAL NOTES:
1. Contractors work Is to conform to alt local ordinances and NYS Bugdl~g and Energy Conservation Code, latest
edition(s),
2. All Electrical, Piumtiing and HVAC work shall be governed by all National, State and Local Codes, latest
edition(s).
3. All connections of water supply lines ~re to be made with 95~5 solder as aP~ErOVed by Sl~ffolk County
Department of Health SewIces with certificate of compliance provided upon completion. -
4. Contractor(s) shal{ verify afl field conditions and dimensions and will b~ responsible for same. Any
discrepancies shall be reported .to the Archito~t immediately. '
5. Contractor(s) will cooperate with all other trades and will complete-work In accordance with best standards
and practices. ._
6, All dimensions are nominal and take precedence over scale. All abbreviations are standard.
7. All items of work on the drawings are new, unless otherwise not~.
8. Proprietary names identifying Items ~f work are used so · y o prescr be standards of construction. Items of
equal quality may be submitted to the Architect for conaldergtion u*~les s noted otherwise.' - -
9. All wood frame construction shall conform to the American Forest ~. Papot' Assm=tatton "WOOD FRAME
CONSTRUCTION MANUAL" Iggg SBC - HIGH WIND, latest edition.
t o, All high wind resistant structural metal connacttons shown on the drawings, or required by code from the roof
to the foundation are to be manufactured by "SIMPSON Strong.Tie- and be "Z-Max" coated. Conn~J/ors which
are near, dn or ~below grade must be fabricated of type 316 stainless steel.
11. AIl wood fram ng members shall have an allowable extreme fiber stress equal to or greater thin-structural
AA,.
architect
~]~-~ ] 1230 Travel.er Street SouthoJd N,Y. 11971