The URL can be used to link to this page

Home My WebLink About33761-ZFORM NO. 4 TOWN OF SOUTROLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUP~qCY No: Z-33467 Date: 12/30/08 THIS CERTIFIES that the building ADD/ALT & AS BUILT DECK Location of Property: 570 CRITTEN LA SOUTHOLD (ROUSE NO.) (STREET) (HAMLET) Colknty Tax Map NO. 473889 Section 70 Block 12 Lot 13 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 19, 2008 pursuant to which Building Permit No. 33761-Z dated MARCH 25, 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 ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AMD AN AS BUILT DECK ADDITION AS APPLIED FOR. The certificate is issued to GARY AND LORI LEIBLEIN ( OWNER ) of the aforesaid building. SUFFOI~ CO~DEPART~T OF H~J~THAPPROIL~L N/A RY~-r~IC~J~ CERTIFICA~ NO. 8273 05/29/08 PLI~4BERS CERTIFICATION DA'rK43 12/22/08 CHAMPION PLUMBING & HEATI Rev. 1/81 , o~j JJq ~ TOWN OF SOUTHOLD DE ~} fl 2008 i TOWN HALL I I ! 765-1802 b~DG. DEPT. -"-~ WN QF $0uTHO! r~ L ..... APi;LiLATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department 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 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 responsible for the 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 "pre-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 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. 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 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) Location of Property: ~'~ ~ ~',+"~fh~ ~ House No. Street Owner or Owners of Property: O-~Cif'b ~ L~ i"~ Hamlet Suffolk County Tax Map No 1000, Section Subdivision Oq O Permit No. '5~"~(o[~ Date of Permit. Block OO ! ~'~, Filed Map. Applicant: Lot O I "~ Lot: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,~J~,F"J~) Underwriters,Approval: ,/~'ot)/-~,~7 ( Final Certificate: (check one) Applicant Signature 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. 33761 Z Date MARCH 25, 2008 Permission is hereby granted to: GARY AND LORI LEIBLEIN 570 CRITTENS LA SOUTHOLD,NY 11971 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AND AN AS BUILT DECK ADDITION AS APPLIED FOR at premises located at 570 CRITTEN LA SOUTHOLD County Tax Map No. 473889 Section 070 Block 0012 Lot No. 013 pursuant to application dated MARCH 19, 2008 and approved by the Building Inspector to expire on SEPTEMBER 25, 2009. Fee $ 600.00 Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined Approved Disapproved a/c Expiration ,20 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the tbllowing, before applying'? Board of Health 4 sets of Building Plans Plalming Board approval SurveZ Check Septic Form N.Y.S.D.E.C. Trustees Flood Pemfit Storm-Water Assessment Form Contact: Mail to: ~ Phone: · - APPLICATION FOR BUILDING PERMIT Date 3//'~ f ,20 O'~ 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 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 tbr 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 fi'om 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 lbr 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. ,f-0,_~ (Signature~applicant or name, if a corporation) 570 (Mailing address of/applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises &r~ ~- ~__.Or,-j Z~./~.~"/,4// (As on the tax roll or latest deed) If applicant is a corporation, signature of duly author/zed officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Locatip(~ of ,an~t,~._] (~77hich'{' e (~Dpr°p°se~°rkL fie will be done: House Number Street Hanflet Section Block Filed Map No. /3 County Tax Map No. 1000 Lot Subdivision Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~W~q ~¢_ '~-1,~-~ [,4 ('~'~1,(~1C' G I b. Intended use and occupancy ?3,¥~h,\e '~t~-)~[~-/ ('¢-% ,d~l')C (' ,,// Alteration Addition Other Work 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~f~ "'~ ~'-t cr2)c_:) . 5. If dwelling, number of dwelling units If garage, number of cars Fee 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~//[, ~/ ~ Rear Height ///L ~/~ Number of Stories (Description) (To be paid on filing this application) Number of dwelling units on each floor _Depth 2-$, ~ 8. Dimensions o.f/e,)2_tire new construction: Front Height / 7'2.- ~5,~~' Number of Stories 9. Sizeoflot: Front Rear 10. Date of Purchase Dimensions of same structure with alterations or additions' Front -~2,/~/ --~ DepthSq. ~'~ Height ///Z--.%:¢/-"7' ' Number of Stories /~' Depth ('fl'~f[ +- , Rear .Depth Name of Fenner Owner ,Rear /Ce_ 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO f 13. Will lot be re-graded? YES NO ~Will excess fill be removed from premises? YES__ NO -- 14. Names of Owner of prj3r~js_es Name of Architect Name of Contractor Address~'~'O C/J~'~,6/S (_34- Phone No. '7~._('- ~ Address ~Tt'~zz~%zr-va'~///6'$' Phone No ~O~ - C/goC~ 7 Address Phone No. NO 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 BEz,,KEQUIRED. 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. STATE OF NEW YORK) SS: COUNTYOF ~ o~:¢,lk) ~ Aa.-/ /--- ~ ~- ~, i¢~ r--- being duly sworn, deposes and says that (s)he is the applicant (Name of indi¢idual signing contract) above named, (S)ne is the ~ 0.3 ~ eno,. (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 ] q4,~, dayof ¢,x,~,l,, 20~ ~ "~~lic oh~M?Ju~g N , No. 01JU~059400 Qualified In Suffolk County Commission ~-xpires iViay~9, 20 ~ I Signature of Applicant TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INSULATION ,~ FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: - DATE /'~' ~/'~ '~ ~ ff INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/~NSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~o~..~_!..r~"~ ~c_ ~;:;--~r DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION 1ST ] FOUNDATION 2ND [ ] ROUGH PLBG. [ ,~SU LATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ REMARKS: ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ] F/F/F~NDATION 2ND [ ] INSULATION FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTR_UCTION [ ] FIRER,ESISTANT PENETRATION REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. []INSULATION [] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION DATI INSPECTOR. TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDAT~ [ ] INSULATION FRAMING ~ [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ~'~'FOUNDATION 1ST [/~FOUNDATION 2ND [ ] FRAMING / STRAPPING ] FIREPLACE & CHIMNEY ] ROUGH PLBG. ]INSULATION [ ] FINAL ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: / ~'~' '~ ~ ~ DATE FI:ELI) INSPECTION REPORT [ DATE ROUGH F~G & S~ATE E~ ERG~ CODE / / / / - P- HAM PION PLUMBIN~ ~ H EATING~ INP-, ~31-767-7291 December 22, 2008 To whOm it May Concern, I, Steven M. Rizzuto, hereby certify the all-solder connections for heating project for the Leiblein residence at 570 Crittens Lane, Southold NY 11971 are lead-flee solder connections. My Suffolk County Master Plumber's License # is 38330-MP. Steven M. Rizzuto Champion Plumbing & Heating, Inc. LOIS J. ACCATTATO NOTARY PUBLIC, State of NeW Yo~ No. 01AC6090807 Qualified In Suffolk Courff~ Commission Expires April 21, Nassau Suffolk Electrical Inspections,Inc. P.O. Box 549, Aquebogue, New York · 11931 Tel: 631-591-3097 Fax: 631-591~3098 Application: Issued to: Adtl ress: Village: 8273 Date: 5/29/08 Leiblein 570 Critten Lane Introduced By: Laurel Lighting Inc. Southold License #: 4718-ME Residential [] Commercial The following was examined and approved up to the above date and found to be in compliance with the NEC: Attic Is' Floor [] 2''a Floor [] 3~a Floor Garage Conversion Basement [] Hot Tub Addition [] Detached Garage Pool ~ itches Receptacle Fixtures G.F,I Dimmers Smoke Detectors 9 20 17 9 6 I:ans Dish;;rashcr Washer/Amps Dryer/Amps Oven Range/Amps Carbon Monoxide 2-Paddle rims I:unlacc ( )il ~.ias I leal Znnes Whirlpool Bell Translbrmers Final Insp. Meter Amps Phase Motors ]l 5/30/08 ()filer I'~qtdpmcnt: I-/one Central A/C Permit#: 33761-Z This certificate must not be altered in any manner PETER E. TOKAR ARCHITECT 3718 SOUND AVENUE, RIVERI IEAD, NEW YORK 11901 (631) 208-4097 FAX: (631) 208-4099 Town of Southold Building Department Main Road, Southold, NY 11971 April 15, 2008 Attn: Building Inspector Re: Leiblein Residence, Southold To Whom It May Concern:, Please be advised that at the request of Mr. Gary leiblein, I have inspected the existing p.c. footings for the existing deck at the above referenced project and have determined to the best of my ability that it has been constructed, as per our office specifications and conforms to NYS code requirements. Please feel free to contact me if you have any questions or concerns. Very Truly Yours, Peter 3:Ol~ar, A.I.A. p~rchitect REScheck Software Version 4.1.2 Compliance Certificate Project Title: Leiblein Addition Report Date: 03/10~8 Data filename: C:~Docurnents and Settings~tl Users~Docurnents~.eibtein Addifion~Leiblein Energy Calce.rck Energy Code: 2000 IECC Location: Southold, New York Construction Type: Slrtgle Family Giazing Ama Pementage: ~3% Heating Degree Days: 5572 Construction Site: Owner/Agent: Designer/Contractor: Compliance: 3.1% Better Than Code Maximum UA: 129 Your UA: t25 Ceiling 1: Cathedral Ceiling (no at,c) Wall 1: Wood Frame, 16' o.c. Window 1: Wood Frarne:Do~ble Pane with Low-E Floor 1: All-Wood Joistrrmss:Over Unconditioned Space 429 21.0 0.0 21 725 13.0 0.0 52 96 0.340 33 429 21.0 0.0 19 Compliance Statement: The proposed building design described hem is consistent with the building plans, specifications, and other calculations s~bmitted with the permit apflticafion. The proposed building has been designed to meet the 2000 IECC requirements in REScheck Version 4.1.2 and to comply with the rnanda~o~y req uiramente listed in th~,~'/~"~P~ction Checklist Project Title: Leiblein Addition Page I of 4 Data ~ecerne: C:~Documents and SettingsVdl U ea~stDocu ments~Leiblein Addition~eiblein Ene~jy Celcs.rck Report date: 03/10/08 REScheck Software Version 4.1.2 Inspection Checklist Date: 03/10/08 Ceilings: I-I Ceiling 1: Cathedral Ceiling (no attic), R-21.0 cavity insulation Above-Grade Walls: I-I Wall 1: Wood Frame, 16' c.c., R-13.0 cavity insulati~ Comments: Windows: Windew 1: Wood Frame:Double Pane with Low-E, U-factoc 0.340 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? Comments: Yes __ No Floors: [] Floor 1: All-Wood JolaVTmss:Over Unconditioned Space, R-21.0 cavity insulafian Air Leakage: I-I Jeints, panetmtions, and all othe~ s~ch ope~ngs in the building envelope that are sources of air leakage are sealed. [] Recessed ligl~s are 1 ) Type lC rated, or 2) installed inside an appropriate air-tight assembly with a 0.5" ctearan(3e from combustible materials. If non-lC rated, fixtures are installed with a 3" clearance from insulation. Vapor Retarder: [] Installed on the warm--in-winte~ side of all non-vented framed ceilings, walls, and floors. Materials Identification: [] Materials and equipment am installed in accordance with the manufacturer's installation ins~uctlens. [] Materials and equipment am idenfit~ed so that compltarme can be determined. Manufacturer rnanuale for all installed heating and cooling equipment and service water heating equipment have been provided. [] Insulation R-values and glazing U-factors are dearly marked on the bsilding plans or specifications. [] Insulation is installed according to manufacturer's instnJCfions, in substantial contact with the surfac~ being insulated, and in a manner that achieves the rated R-veiue without compressing ~ insulation. Duct Insulation: [] Ducts in unconditioned spaces are insulated to R-5. Ducts outside the building are insulated to R-6.5. Duct Construction: [] All joints, seams, and connections are securely fastened with welds, gaskets, mastics (adheaivea), mastic-plus-embedded-fabric, or tapes. Tapes and meatice are rated UL 181A or UL 181B. Excep#ons: Continuously welded and Iocldng-typa longitudinal joints and seams on ducts oparatJng at less Ran 2 in. w.g. (500 Pa). [] The HVAC system provides a means for helancing air and water systems. Temperature Controls: [] Thermostats exJat for each separate HVAC system. A manual or automatic means ~3 partially restrict or shut off the heating andlor Project Title: Leiblein Addition Page 2 of 4 Data filename: C;~Documente and SettingsV~ll Uears'~)ocu me nts\Leiblein Addition~eiblein Energy Calcs.rck Report date: 03/10/08 Service Water Heating: ~ Water heaters v~th ver'dcal pipe risers have a heat b'ap on both the inlet aM outlet unless the water heater has an integral heat trap or is pert of a circulating system. [] Circulating hot water pipes am insulated ~3 the levels in Table 1. Circulating Hot Water Systems: [] Circulating hot water pipes are insulated to the levels in Table 1. Swimming Pools: r-IAIl heated swimmteg pools have an on/off heater switch and a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps have a time clock. Heating and Cooling Piping Insulation: [] HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F am insulated to the levels in Table 2. Project Title: Leibidin Addition Page 3 of 4 Data flename: C:~Documents and SettingsVUI Users~Documents\Leiblein Addition~eiblein Energy Calcs.rck Report date: 03/10108 Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes Insulation Thlclm~ in Inches by Pipe Si=es No~.Clrcula~ng Runouts Circulating Mains and Runoute Heated Water Up to 1" Up to 1.25' 1.5" to 2.0' Over 2' Temperature (°F) 1~-1~ 0.5 1.0 1.5 2.0 140-1~ 0.5 0.5 1.0 t.5 1~-1~ 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes Insulation Thlclmees In Inches by Pipe Sizes Fluid Temp. Piping System Types RanGe(OF) 2" Runouts 1" and Less 1.25" to 2.0" 2.5" to 4" Hestlng Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant and 40-55 0.5 0.5 0.75 1.0 Bdne Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD: (Building Department Use O~ty) Project TCLle: Lelblein Addition Page 4 of 4 Data ~ename: C:~Documenta and SettingsVUI U ears~Docu me nt s~Leiblein Addition~Leiblein Energy C. alcs.rck Report date: 03/10108 '~ ~:,~ ~ 7:~- /z-/c~ TOWN OF SOUTHOLD ~I~OPERTY RECORD CARD /V" !£ R~S. Z! LAND SEAS. IMP. TOTAL DATE AGE VL 1 FARM BUILDING CONDITION ' VI LLAGE W DISTRICT SUB. ACReAgE ,~,~ TYPE OF BUILDING LOT NEW NORMAL ABOVE Farm Acre Value Tillable 1 Tilloble 2 Tillable 3 Wcodland Swampland Brushland House Plot BELOW Value Per Acre I Total ~ M. Bldg. Extension Basement Ext. Walls Bath Floors Extension Interior Finish Extension Fire Place Hea!t Porch Attic Porch Rooms 1st Floor P~tio )~,fveway Breezewa, Garage O.B. Rooms 2nd Floor ,~+ ~ ~, /~J tA, i A, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located et ,~. ,/.,J,.....(~...~.~..~,.,~l....~...O..~..~..~.... Street Map No.....JJ~g.~iLrGgl~lock No. ,.?.?..e.. ............... Lot No..~t' ............................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~alll..~,~........, 19....~, purSuant towhich Building Permit No ........ ~'..~ ....... doted ............................... ~..~. ...... 19.~q..,wos issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ................ ................................................ i T lt IBfJg l:Jli ............................................... This certificate is issued to ~..{~...~,J~,~ilJt...~ .................................................................... (owner, lessee or tenant) of the aforesaid building. / Building Inspector FOIr, M NO. ~ TOWN OF $OU?8OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 723~ Z D~te ................. Jura..2..7, ......................... ~9 ...... Permission is hereby granted to: . J..,...G. ,...~,r.~,lt .................................................... &~utho:Ln ~..lee..l~ork. ........................................... to ~l~e~41..llM:[:t,~la..l~'..2..~lZ'..~l.~l~l..,~...I;K[liL~,~.. MI..~'#P.~.~..~..; ..................................... at premises located at ..~.]ll.t,...l[I.~.e...~T.~.t,.~.l~.~...~.....e.J....,~..:'.u..:'i.c..*...~ .................................................... ...................................... lea~.~aat, lmhte. II~..~o~l[ ............................................................... pursuant to application doted .......................... ~IIt.~"Z. ....................... 19.~..., and opproved by the Building Inspector Fee $5.00 ................ Building Inspector TOWN O~: SOUTHOLD BUILDI14G DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, 14. Y. Examined .......... Approv, d ........... ~-~.~...~..19...~./~'~'ermit No......."~..~.~- ........ [Building nspector) ~;~/ Application No.... **~.~.~.. ........... APPLICATION FOR BUILDING PERMET ......................... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of praperty must be drawn on the diagram which is part of this location. 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 permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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 Saul'hold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alteretions, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, it a corporation) (Address of applicGnt) State whether applicant is ~nt, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premlses......~..-.~...~...~--~.~.:~:.~....z~,-,~- .................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which~orapceed work will be done. Map No~.~----~.... Lot No: .,.~.....~........ Street and Number ....~~~.,......~-~-.~./.~.~ .................... ~...~. ........................ - ' MuniEipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~.~...'.7"~' ................................ : ............ .; .................... i ...................... b. Intoned use end occupon 3. Nature of work (check which applicable): New Building .................... Additioo .......&c~.........'.AIteratlon .................... Re?air .................... Removal,~.~,~ .................... Demolition .................... ,,e__ ,~,-iOther Work (Describe) .................... · (to be paid on filing this application) 5. if dwelling, number of dwelling units....~~umber of dwelling units on each floor ............................ If garage, number of cars ..................... ~ ............................................................................................... 6. If business, commercial or mixed accuponey, spec ify nature and extent of etch type of use .............................. Dirnensions of existing structures, ,, any: Front.........~....~.... ......... Rear ........ ~ .......... Depth....°~...~..... ......... 7. Height ............................ Number of Stories ....../../o~-.~'..;; ....................................................................................... Depth~.~./...c~'.~. ........... Height .............................. Number of Stories ................................. 8. Dimensi~ of entire now construction: Front.....~....I.,, ......... Rear ............ ~....~... Depth ....r~.....~......./. ..... ' Height .......-.' .................. Number of Stories........~... ................ 9. Size of lot. Front ....... .~..~ ....... Rear ............................ Depth ....~--/..~....~../..~_~'~/~--- / ,0. Dote of Purchase ./.~ Nome .f For~er Owner ~~~ 12. Does proposed coostruction violate,any zoning Iow, ordinance pr regulation? ....~/ .............................................. 13. Name of Owner of premises .~/x/.~'.~...'.~/.."~Address~' "/ ~'~ '~ ~~..~ ......... Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phons NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM . Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block numbers or description according to deed, and street names and indicate whether interior or corner lot. ? - STATE OF NEW~.C)~;,.//' ) S S COUNTY OF~.) ~ · .......................... .~..d..~,,~...~...~ .............. being dul~/swam, deposes and says that he Js the applicant (Name of individua~)gnin, n_~gg a,,~pplicatipn) above named. He 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 makeand file this application; that all statements contained in this application are true to/413e bes[ · and that the work will be performed in the manner set forth in the oppllcat~6n [lle_~i'ewith. Swam to bafore r~e this (. ~_~_.~ ~. ~ /C,~ ............ ................. Notary Publ,~.~.,c~wr-.~.----..~~ ....... o~ ~,~,0'~ ~o..,~ , Tow n o_ f Erosion, Sedimentation & Storm Water R_un-off ASSESSMENT FORM PROPERTY LOCATION: $,C.T,M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMI881ON OF A District Section Block Lot STORM-WATER, ORADING~ DRAINAGE AND EROSION CONTROL PLAN CERTIFIED BY A DESIGN IPROFESSIONAL IN THE STATE OF HEW YORK. Item Number: 2 (NOTE: A Check Mark (~) for each Question is Required fofi a Complete Application) Yes No Will this Project Retain AI~ Storm-Waler Run-Off Generated by a Two (2") Inch Rainfall on Silo? v~ r-~ (This ilem will include all run-off created by site clearing and/or construction activities as well as all Site 3 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 WaterFIowl 4 Will this Project Require any Land Filling, Grading or Excavation where thero is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Dislurbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? 6 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? 7 Wilt there be Site preparation on Existing Grade Slopes which Exceed Fifteen (t5) feet of Vedical Rise to One Hundred (100'} of Hofizonlal Distance? 8 9 Will Driveways, Parking Areas or ether Impervious Sud'aces be Sloped to Direct Storm-Water Run-Off into and/or in the direction of a Town right-of-way? Wd{ 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? I-Lq/ NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in the Box, aStorro-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit! EXEMPTION: Yes No Does this project meet the minimum standards for classification as an AgdcuRural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Required! __ STATS OF NF~W YOP, R, Tha~ I,..~J ~ ~ ~.~ being duly xwot n, d,*l,o;es and 5tys ~at he/she is the applicfmt (o~ e , co i ac o , Agent, Co borale Officer, eIc ) Ow le a/d/'o rcp~ sc~ taux, eot fl~e Owue~ o[ Owuc]'s, and is duly aufl~oHzed tn perl0rm n~ have perhamed m~e and file dUs appEca~on; that MI smtemen~ confined in ~s application a~ e n~e to ~c best of t2s knowledge mid belief; and fl~a( d~c work will be pellbrmed in dm IllaJMqCI 5ct IBrth m fl, c application Iiled Sworu to before me this; FORM - 06/07 .o. 01JU6059400 Commis P Y , S,C,T,M. NO, DIS]RICT: 1000 SEC'FION: 70 BLOCK: 12 LOT(S): 13 LOT 24 LOT 23 LOT 25 ADD PROPOSED ADDITION 05-17-08 UPDATE SURVEY 11-19-07 AREA: 44,114 S.F. OR 1.01 ACRES £LEVATIONDATUM: ................... UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF ~-IE NEW YORK STATE EDUCATION LA~ COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COP)~ GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR ~tYOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO TI~E TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO TI~E ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SNOF,,1V HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINGS OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL S1RUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUC'TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 24 MAP OF: SOUTHWOOD FILED: NOVEMBER 24, 1953 AS #2141 SITUATED AT: SOUTHOLD TOWN OF: SOUTHOLD SUFFOLK COUNTY, NEW YORK FILE # 26--119 SCALE: 1 "=40' DATE: MAY 26, 2007 N. Y. S. LIC NO 50227 CERTIFIED TO: GARY LEIBLEIN; LORI LEIBLEIN; MID-ISLAND ABSTRACT; (TITLE #MID-07-888S) KNNNETH M. WOYCHUK L.S. Land Surveying and Design P.O. Box 3, Mattituek, New York 11952 PHONE (831) 298-1588 FAX (631) 298-1588 ~~~ APP.ROV. ED AS NOTED FEE:4'~.~--~ NOTIFY BUILDING DEPARTMENT AT ~ ~ FOLLOWING INSPECTIONS: ~ 1.FOUNDATION ' ~0 REQUIRED ~ ~ % FOR pOURED CONCRE~ I ~ ~ ~ 2, ROUGH - FRAMING & PLUMBING ~ ~ ~ 3. INSU~TION ~ ~ 4. FINAL-CONSTRUCTiON MUST ~lNl~ UNiFOR~LT DIBTRIEUTED LIVE LOAD5 BE COMPLETE FOR C. , E ALL CONSTRUCTION SHALL MEET TH ~ ~ ~1 UR~FNTS Of THE CODES OF NEW ~ II .J ' RETAIN STORM WATER RUNOFF ~ PURSUANT TO CHAPT~ ~6 ~ 5~9~ LCODESOF GLAZING PROTECTION FRO~ HIND-BORNE DEB~I~ NeW YORK S~TE & TOWN CODES ,.o"? ' - OCCUPANCY OR ~OODZO~~~~ ~FUL COMPLYWITH C~F~.~ WITHOUT CERTIFICATE ~' J~ FLOOD DAMAGE PRE~E~I~ ~ ............. =~. -- SOUTHOLD T~ODE. U~ UUUUFAN~Y TYPICAL- DETAIL- EXTEt~IC:)I~ HEADER.~ (~FLR,-TO-FND. CONNECTION~ (~ HALL--TC)--FND. CONNECTION-~ I I ®) ® F / r NAILING ~CNEDULE G EN EF~AL NOTES, NO SUBSTITUTION5 NOTE, TMIS SET OF PLAN5 HAG BEEN DESIGNED IN ACCORDANCE HIT~4 THE AMERICAN FOREST AND PAPER AS~:~CIATION (AF¢ PA) NE)OD FI~AME CONSTRUCTION MANUAL I~OOF SHEATk41NG NAILING 5CkIEDULE NALL St-IEATI-IING NAILING SCklEDULE I No Date Title REVISIONS: Drawn By: Date: ~HEET No.. 1 SHEETS I I EX EX¸ Ni='i,~ ~ILSPACE EXIST. E,$MT. EX, CTYP ) -- (~)- F.J. FOUNDATION PLAN No. ~.EVISIONS:Date UP EX. , EXIST, DECK DH NOTE, VERIFT ALL EXISTINC~ CONDITION5 AN]3) CLEARANCE5 II II LEGEND EXI.ST. KITCHEN P, IALL NEI~I DININ~ -~d~ LIVING ROOP1 F,,' dk ~<<~ ~.~ (:~.3 -2"× 12" (AS FILL IN DOOR FIP. ST FLO01~ PLAN 512 5.F, Dote Title 3 DN L NEW POI~IA IN/ EX, DEN SECTION SECOND FLOOR PLAN VENT EX. BEDR. Oor'I ~A~-L. II ~ Ii d DEN EX. ii LIVING ii II EEX. BA..'~Er'IENT ~ECTION EX, EX, F 45: Dote Title Il EX, FRONT ELEVATION II II RIGHT ELEVATION Date 'it{e EX ADDITION (tYm) IEX, EX. Ii II LEFT ELEVATION REVBION$: No. Dat. e 6 ~×IST. >N EXIST, HOUSI~ PLAN EXJSTING EXISTING -Iii Ill I~l I I I ] f~XI ~T. HOUSE FOUNDATION PLAN I0"~ [:)lA. POUI~ED CC)NC, IISONOTUSESI' CONC. FOOTING (TYP. ,) (VEl~l FY) D TAII NOTE: TFIESE PLANS I~EPRESENT AN EXISTING DECK: ADDITION AND HAVE BEEN D~A~N BASED ON VISiBlE INSPECTION. PORTIONS OF TNE EXISTING STrUCTUrE ARE NOT VISIBLE. T~ESE A~EA~ ARE LABELLED A~ "EXISTING". A~C~ITECT NO% ~ESPONSIBLE FOR AS-BUILT CONDITION~¢ AND METNOD5 NOT VISIBLE IN FIELD. MATERIAL D REVISIONS: D-1 OF ~EETS il EX, F EX. EX, (TYP.) --~ Ni='N 6P. AI,, IL~PACE (2)- F.J, ('2)- F,J. 'Il q _J ACC:), EXIST. ~LAB < Z FOUNDATION PLAN REVISIONS: Date Titte 2 EXIST. DN EXIST. EX. NI=I,,I C.I~AI~IL~PAC. I= SECTION SCALE, SECOND FLOOP. P/AN EX. I~,IE J:>F~.OOh' ir EX. LIVIN~ EXIST' r'-- ^LIGV I EX. BA~,EMENT VENT =i..E~.i=i.I R-21 [~'ATT, IN.~UL. C.I:~AI~IL~PAC. E --.COMPACTED FILL (~) 51ECT ION [ cV~N~D%Tt 'oANL~ ] F I tJ Y4 =1'--0ii Z CC ~EVI~ION~: [Date Title