HomeMy WebLinkAbout34469-ZFORM NO. 4
TOWN OF SOL~fHOLD
BUILDING DEP~RTS[ENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34655
Date: 04/20/09
THIS CERTIFIES that the building ADDITION
Location of Property: 1540 TUCKER LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 59 Block 4 Lot 5.2
Subdivision Filed Map No. -- Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 25, 2009 purs,,~-t to which
Building Pezmit No. 34469-Z dated MARCH 3, 2009
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 DECK ADDITION' TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JOHN A & KATHLEEN D'ANGELO
(OWNER)
of the aforesaid building.
SUFFOI=K CO~qTYDEPART~TOFHEALTHAPPROVAL
E~t-r~ICAL u~KTIFICATH NO.
I~LU~E~S C~KTIFICATION DA'r~U3
N/A
N/A
Rev. 1/81
2009
BLDG.
TOWN OF SOUTHOLO
Form No. 6
TO~I OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
[CATION 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, pr~pe~'y lines, slxeets, and unusual natural or
topographic feature.
Z 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 aolder nsed ia syst~ containn less than 2/10 of 1% lead.
5. Commercial building, industrial building, muitiple x~aldoncea andsimilar buildings and installations, a certificate
of Code Compliance from architect or engineer responaible for thc building.
6. Submit Planning Board Approval of completed site plan requil~menta;
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate sm-vey of property showing ali property lines, street~, building and.unusual natural or topographic
~l~ features.
2. A properly completed application and consent to inapect signed by the applicant. If a Certificate of Occupancy ~s
denied, the Building Inspector shall state the reasons therefor in writing to the applicanL
Co
New Construction:
Location of Property:
House No.
Owner or Owners of Property: ..'"~-"O'l~
Suffolk County Tax Map No 1000, Section
Subdivision
P¢ t No. Zqq
Health Dept. Approval:
Old or Pre-existing Building:
Street
Fees
L 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 Oecupancy 2 $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Oecupan?y - Residential $15.00, Commereial $15.00 /
Date. 4/~ '~/t~
(check one)
Hamlet
Date of Permit.~ -~-
Lot %
Filed Map. Lot:
Applicant:
Underwriters Approval:
Planning Board Approval:
Request for: Temporary C~te
Fee Submitted: $ ~ ~
Final Certificate:
~gnature .
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. 34469 Z Date MARCH 3, 2009
Permission is hereby granted to:
JOHN A D'ANGELO
1540 TUCKERS LA
SOUTHOLD,NY 11971
for :
12X24 REAR DECK ADDITION TO EXISTING SFD AS APPLIED FOR.
at premises located at 1540 TUCKER LA SOUTHOLD
County Tax Map No. 473889 Section 059 Block 0004 Lot No. 005.002
pursuant to application dated FEBRUARY 25, 2009 and approved by the
Building Inspector to eX~ire on SEPTEMBER 3, 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 PENETRATION
REMARKS:
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGHpLu1ViBI~GFRAMING &
INSULATION PER N. Y.
STATE ENERGY CODE
__ ADDITIONAL COMMENTS
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 OC[
FEB 25
BLDG. DEP]',
TOWN OF SOUTHOLD
PERMIT NO.
l/Er-
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 Form
N.Y.S.D.E.C.
Trustees
Flood Pernfit
Storm-Water Assessment Form
Contact:
Building Inspector
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
,20 &~}
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 alter 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 re?~lations, and to admit
authorized inspectors on premises and in building for necessary inspections. /,~ ~,~ .~'~ ,,,~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises ~0~t~ ~> I- )~C
(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:
/5'40 TV c
House Number Street
Hamlet
Block ~
County Tax Map No. 1000 Section _~ Lot ~'-t ~
Subdivision --t Filed Map No. Lot
2. State existing use and occupancy of premises a{ld intended use lind
a. Existing use and occupancy 5r &~f {~ ~ %
b. Intended use and occupancy ~La,ql. ti/// /'O-~.or-
3. Nature of work (check which applicable): New Building. Addition
Repair Removal Demolition Other Work
Estimated Cost ~~ Fee
If dwelling, number of dwelling units
If garage, number of cars
occupancy of proposed construction:
Alteration
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
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 . D..e~...t_h
Heght Number of Stones ~j
Dimensions of same structure with alterations or add tons Fr~cn-t-'~ _ _ ;i ' Rear
Depth Height ....---"~ umber of Stor ~'.~1 ii
8. Dimensions of entire new construction: Front ~ Rear '~
9. Size of lot: Front ~ Rear .Depth
10. Date of Purchase J Name of Former Owner
11. Zone or use~hich premises are situated ~--'x- '~(-~
12. Does pro/lxfsed 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
14. Names of Owner of premises 1) [,~.tO~-e(o Address [¢4.C~ 'l'or.~..~-"¢.~ Phone No.
Name of Architect ~_)/2 Address Phone No
Name of Contractor Address Phone No.
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.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet ufa 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:
COUNTY OF )
~-~/--/-.- ~ ~-'(~,_- ~)~1.~/~ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the t~~
(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·
Swum to before me this /~-: _ .-~ ~
c~O ~ day of l'"'~ 20 O 7-- /.-/~..~' ~J.~.-,
- - .. ....... ry,abhc, St~te of New York ,¢' c.-' ... - ! / 1. /,. ,
?qorary ruonc QualiN~..0.1T0~6.1.9.0.6_96 . ~gn u~.gr, e o[.~sppncant
8rl lU ~iUti'OIl( ~ourlly ~ ~
Comm~ssiorl Exp res July 28, 20 t
TOWN OF SOUTHOLD PIIOPEilTY ~D CAI~ ~
OWNER STREET / ~' ~//0 VILLAGE DIST. SUB. LOT
FORMER OWNER ~-~--~J-~ N E ACR., /-/
),ES. ~-I ~ SEAS. VL ~ FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
?~ o 2°° . ~A~ ,Y4,~,,z,~:~o~'"'"'-'-~--~'~'"~'~"~.~..~.,,~.,,,~-
/
'ill,hie FRONTAGE ON WATER
go~lond FRONTAGE ON ROAD
Ae~dowl~d DEPTH
~ou~ Plat BULKH~D
'otol
COLOR
TRIM
Extension
Extension
Extension
Porch
Porch
Breezeway
Garage
Patio
Oo Bo
Total
Foundation
Basement
Ext. Walls
Fire Place
Type Roof
Recreation Room
Dormer
Beth
Floors
Interior Finish
Heat
Rooms 1st Floor
Rooms 2nd Floor
Driveway
Dinette
LR.
BR.
FIN. B
Tow:n o__f Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: $.C.T.M.~. THE FOLLOWING ACTION8 MAY REQUIRE THE SUBMISSION OF A
~ D~I** dot don ,'o~ck ~'~'" 8TORM-WA,~"~ GRADING! DRAINAGE AND EROSION CONTROl. PLAN
CroCi iriED BY A DE81GN ROFESSIONAL IN THE STATE OF NEW YOlk'
Item Number:. (NOTE: A Check Mark (~) for each Question is Required for a Complete Application)
Yes No
1
2
Will this Project Retain All Sthrm-Watar Rur~.Off Generated by a Two (2") Inch Rainfall on Site?
(This Eom will include all mn-off created by site ciesflng and/or construction activities as well as alt Site
Improvements and the pewnanent creation of in~ surfaces.)
Does the Site Plan and/or Survey Show Ail Proposed Drainage Structures Indicating Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Cofltmlling Surface WatonClowi
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 Cub c Yards of Material within any Parcel?
4
Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Surface?
5
Is them a Natural Water Course Running through the Site?
Is this Project within the Trustees urisdiction or within One Hundred (100') feet of a We land or Beach?
6
Will them be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
7
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?
8
9
Will this Project Require the Placement of Matedal; 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?
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 Bu ding Pemlltl
EXEMPTIONt Yes - No
Does this project meet the minimum standards for classification as an Agdcuiturel Project? /
Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requiredl --
STATE OF NEW YORK,
COUNTY OF ........................................... SS
That I,~~....~ ............. being duly slqorn, deposes and says that he/she is the applicant for Permit,
(Name of individual signing Dccumenl)
And that he/she is the ........ ~... . ...
(O~mer, Ccntra~toq Agent. Corp~ate Officer. etc.)
Owner and/or representative of the Owner of Owner's, and is duly authorized to perform or have perforated 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 herewith.
Sworn to before me this;
............... .................. dayo,....C<&.. " .........................
Notary Public.-~..~.......~..~...-.~..~lN.r~..fl2,~l'~fl6fl6.modm ~ffolk County ..... b. "' ' '": ................................
uomm~ssion £x~ires July 28, _~ /
FORM - 06/07
EXISTING
BOW
WINDOW
EXIDTING GRADE
EXISTING
EXIDTING GRADE
ffront Deck Section
5cale:~:' = IllOll
EXISTING REDIDIENCE
Deck ffoundatlon Plan
Scale: 74I' = I'~Oll
RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236
OF THE TOWN CODE,
~XIDTING RESIDENCE
5/4
Deckln~
Deck Section
ALL CONSTRUCTION SHALl.
MEET THE REQUIREMENTS OF THE
CODES OF NEW Y'OF~K STATE,
OCCUPANCYOR
USEIS UNLAWFUL
WITHOUT CERTIFI(
OFOCCUPANCY
AP, PROVED AS
765-1802 8AM TO 4PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR pOURED cONCRETE
2. ROUGH - FRAMING & PLUMStNG
3, iNSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR CO.
ALL CONSTRUCTION SRALL MEET THE
REQUIREMENTS OF THE cOOES OF NEW
yORK STATE, NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
~Deck Plan
Scale:/4" = I'-O"
G' 5hder
P~ISTING DECK
Ex~stmg Deck Plan
NYLIC. 031085-1
PA LIC. 9859-X
PERMIT SET:
Proposed
New Deck
A-1
Nd 8L'qO:gL 6018 L/g- L qD~ct q~Y/IDIQ--H-~IO0~