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HomeMy WebLinkAbout34091-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33391 Date: 11/14/08 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 870 SMITH DR N (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 76 Block 2 Subdivision Filed Map No. Lot NO. SOUTHOLD Lot 13 (HAMLET) conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 4, 2008 pursuant to which Building Permit No. 34091-Z dated AUGUST 6, 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 COVERED PORCH ADDITION AND ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to KEVIN & KATHLEEN MONTGOMERY ( OWNER ) of the aforesaid building. ,~U~'.t'~OLK COUNTY DEPA~T~T OF }~ALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLiErS c~u(TIFICATION DA'r~u N/A N/A N/A gnature 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 ofpropezly 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 respousible for the building. 6. Submit Planmng Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) nou~couforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of properly showiug all properly lines, streets, building and unusual oatmal m topographic features. 2. A properly completed application and conseot Io inspect signed by the applicant. Ifa Certificate of Occul)ancy is denied, the Building Inspector shall state the ~easons therefor ill writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Addi0ons to dwelliog .$25.00, Alterations to dwellmg $25 00, Swiimning pool $25.00, Accessoly building $25 00, Additions to accesso~3, building $2500, Businesses $5000 2 Certificate of Occupancy oa Pre-existing Buildiug $100.00 3. Copy of CertificateofOccupancy $ 25 4. Updated Cell:ificate of Occupaucy- $5000 5. Temporary Ce~.ificate of Occupancy - Resiciential $l 500, Commercial $15.00 New Constm,~tion: Old or Pre existing Building: LocationofProperty:_ ~/7~ ~ /~ e~).//ff, House No. Street suffolk C un y 000, Subdivision (check olle) Hamlet Filed Map, __ __ Applicant: Underwriters Approval: Health Dept. Approval: Pla~ming Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~ t~" o~ Final Certificate: Lot /._~ Lot: (check one) FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PER~IT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERi, IT NO. 34091 Z Date AUGUST 6, 2008 Permission is hereby granted to: MONTGOMERY PO BOX 1758 SOUTHOLD,NY 11971 for : ADDITION/ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 076 pursuant to application dated AUGUST Building Inspector to expire on FEBRUARY Fee $ 200.00 870 SMITH DR N SOUTHOLD Block 0002 Lot No. 013 4, 2008 a/id approved by the 6, 2010. ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] ~L_ ATION [ ] FRAMING / STRAPPING [/,,,]/FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESi,.STANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS. ~ DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: /o~ -~ DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 I NSPECTION [.~/] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION [ ]FOUNDATION2ND []FRAMING/STRAPPING []FIREPLACE&CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ REMARKS: DATE INSPECTOR--~/~ ~POR.T I DAT]: FOUNDATION (~.ST) COM2~NTS FOUNICATION (2ND) ROUG~t FRAM~G & LNSLrLATION PER ~q. Y STATE ENERGY CODE ADDITIONAL COM1VI~NTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 · TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southoid/ PERMIT NO. ~ q ~ ! ~ 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 N, Septic Form N.Y.S.D.E.C. ~ ~ Trustees Examined ~X I ~ 20 x,~* Contact' ' ~ InspeCtor ' ~B~ ~ CJ~3B ; ~PPLICATION FOR BUILDING PE~IT ~ Date 4 ~ ~O~T 2008, .... ~STRUCTIONS 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 throbghout the work. e. No building shall be occupied or used in whole or hi 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. lfno 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. APltL~CATION 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..~)[.j~ ~ /,~l~_(/~_j.)/t .: · ]'~ ~¢SCignaturd]o f applicant or name, if ~--7 (Mailing address of ap~plicant~ applicant is owner, lessee, agent,~engineer, general contractor, electrician, plumber or builder State whether Nameofownerofpremises ~1£.~' ~[X. ~.Vt~} (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: House Number Street Hamlet County Tax Map No. 1000 Section Subdivision ~_~oOSt~ /0~CJa (Name) Block ~_ Filed Map No. /66,3 Lot 13 Lot qT, ~t3 ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,~qL~ ~S)~/~ b. intended use and occupancy S,~(~ F~,o~ 3. Nature of work (check which applicable): New Building Addition Repair Removal Demolition Other Work 4. Estimated Cost Fee 5. If dwelling, number of dwelling units t~//1. Number of dwelling traits on each floor If garage, number of cars ~/Pr ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 60.2' Rear 60. ,~ ' Height /,dr'- o" ~ Number of Stories Alteration (Description) (To be paid on filing this application Depth Dimensions of same structure with alterations or additions: Front Depth ~'2, 3' Height_ / 4'- o" ~ Number of Stodes 8. Dimensions of entire new construction: Front Mf~ Height kJ/t~ Number of Stories 9. Size of lot: Front / ~ q- So°t Rear IO6 ' Rear td/p Depth I0. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 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 5~.. ~a. g ~aO'. ~t,0 14. Names of Owner of premises t~,.~rc, o,~ ~ Name of Architect t~. ~a~ t.3t,.~,.~ ~O Name of Contractor 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * iF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. Address rov,-~t.~ at? tt~'~t PhoneNo. 68[ -~h~. t355' Addresst~. ~,~ t?rZt g*~m Phone No Address Phone No. NO ~ :~ 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) AJj¢ I:~ ~o ~------------------g~{- ~, 1.~_ ~ .r~.J being duly sworn, deposes and says thatJ,~e is the applicant (N me of md~vtdual mgning coutract) above named, QHe is the (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 tree 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. Swgr~t.o betbre me this day qf ,~fl,.I~/[I Not~.l]blic 2o?f v Signature of Applicant MELANI£ DOR0$KI NOTARY PUBUO, State of New Yo~ No, 01D04634870 Qualified in Suffolk County ,~ tx ~ ~'~ Commission ENo res Septernbe[ 30,/AJ ( ~ S W SEAS. VL FAP. M ¢0~. I-~ND IMP. TOTAL Tilloble, '~3 Woodland ~q'~Use Plot ^CP.E~G~ TYPE OF BUILDING DATE I~/~RKS J IND. CB, j MISC~ ~ i~? ~ ,,,~,,~ ~v i ,~ ~.' J [ Porch Ro~s Ist Flmr I : ~ R~s ~d Flor :~ ..~(~ ~c:~ ~ Patio ~ ~rOge ~ ~ ~ ,. ~ 8 CORPORATE CENTER DR, 2NO FLR, MELVILLE, NEW YORK 11747-3166 Phone: (631) 756~000 CERTIFICATE OF WORKERS' COMPENSATtON INSURANCE MONSON GENERAL CONTRACTING CO INC 262 JEROME AVENUE MINEOLA NY 11501 POLICYHOLDER CERTIFICATE HOLDER MONSON GENERAL CONTRACTING CO INC TOWN OF SOUTHOLD 262 JEROME AVENUE PO BOX 1179 MINEOLA NY 11501 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER / PERIOD COVERED BY THIS CERTIFICATE DATE H 641 968-3 315581 L 06/22/2008 TO 06/2212009 8/19/2008 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NE'~N YORK STATE INSURANCE FUND UNDER POI. ICY NO. 641 g68-3 UNTIL 06/22/2009, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 06/22/2009 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, t0 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-26.3 NEW YORK STATE INSURANCE FUND DIRECTOR.INSURANC~ PJND UNDERWRITING This certificate can be validated on our web site at https://www, nysif, com/cert/cartval,asp or by calling (888) 875-5790 VALIDATION NUMBER: 66816129 . ACDR CERTIFICATE OF LIABILITY INSURANCE ~ooue~ (631)324-0420 FAX (631)324-3526 THIS CERTIFICATE iS ISSUED AS A MA I I~R OF INFO~MAllON Dayton RJtz & Osborne ONLY AND CONFERS NO RIOHTS UPON THE CERllFICATE HOLDER. THIS CER11FICATE DOES NOT AMEND, EXTEND OR 78 Hat n St. ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. P.O. Box 5099 East Hampton, NY 11937 I INSURERSAFFORDINGCOVERAGE NAIC# 262 3erode Ave ~N~ e: H~neola, NY 11501 C~ERA~S THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE F~:~JCIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS, EXCLLLSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS 0~ u~uw 6900001373-002 12/02/2007 12/02/2008 ~CH OCCURRENCE $ 1,000,00O I CLA~MSMADE [] eCCUR MmEXP(Anyonep~mo.) S 5,000 A X Contractual L¶ab. PERSONAL&ADVINJURY $ 1~000,000 GENERAL AGGREGATE S 2,0~0,000 $ CERTIFICATE HOLDER Totm of Southold PO Box 1179 Southold, NY 11971 ACORD 26 (20el/08) CANCELLATION Harry Frttzon 3r./I~JdDY ~ ~ ©ACORD CORPORAllON 1988 IMPORTANT If the cer~ficate holder is an ADDITIONAL iNSURED, the poiicy(ies) must be endorsed. A statement on this certificate does not confer dghts to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this ce~lJficate does not confer fights to the certificate holder in lieu of such endorsemant(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and b~e cer'dflcste holder, nor does it affirmatively or nega'dvely amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 2S AUTHORIZATION (print owner of property) (mailing address) do hereby authorize Nigel Robert Williamson Architect to apply for a building permit from The Town of Southold on my behalf. S.C,T.M. NO. DISTRICT: 1000 SECTION: 76 BLOCK: 2 LOT(B): 1,:3 SMITH (5©') DRIVE GL5,.*, MHW OF GOOSE CREEK N 39'00'00" E 138.00' ~ O%/ ct 5w;'5 eL 52.3~ ~ ~ EL 52 2 CL 51.22 S 39000'00" W- o.*'s 150.00' s.~'~ LOT ~2~ I LOT ~20 J LOT I THE WATER SUPPLY, ~LS AND CESSPOOL LOCArlONS SHO~ ARE FROM FIELD OBSERVATIONS ~NO OR oAr~ osrAtNrO ~ROU OTHERS AREA: 22.456.2 S.F. OR 0.52 ACRES gcswr~oN o~ru~: ~ .................. UNAUTHORIZED ALTERATION O~ ADDITION TO THIS SURLY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LA~ COPIES OF THIS SURVEY MA~ NOT ~EARING rile ~AND SUR~YOR'~ EMBOSSED SEAL SHALL NOT BE CONSIDERED TO gE A VALID TRUE ~0~ GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR ~OM rile SURVEY IS ~REPARED AND ON HIS BEHALF TO rile TITLE COMPANE GO~RNMENYAL AGENCY AND LENDING LISTED HEREON, AND To T~E ASSIGNEES OF THE LENDING INSTITUTION. GUARANTEES ARE NOr THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERr~ LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE rilEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES. ADDITIONAL STR~CTURES OR AND OTHER IMPROVEMENTS. EASEMENTS SURVEY Or: LOTS 97.98 & 99 CERTIFIED TO: N[VIN MONTGOMERY: BAP OF: GOOSE NECK SITUATE AT BAY VIEW F~LEB: NOVEMBER 22, 1948 AS ~1663 StTUATED AT: SOUTHOLO TOW~ oF:SOUTHOLD KENNETH M. WOYCHUK L.S. SUFFOLK COUNTY. NEW YO~K ~nd Sure,nE ~nd De~i~ ~~ ~ P.O. Box 3..att/tuck, New York, 1195~ ~SO~ (~) ~-tS~ ~ (~) ~*s-15s~ ~ t 28-42 SCA~[: 1 "=20' OAI[: MAY 1 2, 2008 u, Y. s. uc No, 50227 mai~i~in~ ~he ~cord~ of Robert J. DATE: NOTED FEE NOTIF BI AT A'~F..N: 4 PM FOR THE INSPECTIONS: FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ALL CONSTRUCTION SHALL It, REQUIREMENTS OF THE CODE 3lNG 3T -'ET THE 2. ROUGH - FRAMING & PLUk 3. INSULATION 4. FINAL - CONSTRUCTION M[ BE COMPLETE FOR C.O. YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS~Mcr PARTIAL NORTH ELEVATION ,-.,, ~0 l", "' ',J ... ~ ,,PARTIAL FLOOR PLAN Extg. Slab FOUNDATION PLAN ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODE8 OF NEW YORK STATE. Extg. Living Room '~ )~T~ ~ F~SF p~oF I axtg. Basement SECTION Fo. ~,~'oop~. C,E.) bi ~et. PROPOSED COVERED PORCH FOR Mr & Mrs. K. MONTGOMERY 91 SO. FT 870 SMITH DRIVE NORTH SOUTHOLD N.Y, 11971 S,C.TM. 1000-76-2-13