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Home My WebLink About34035-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33717 Date: 05/18/09 THIS ~E~TIFIES that the building ACCESSORY Location of Property: 275 HENRY'S LA PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 74 Block 1 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 19, 2008 pursuant to which Building Permit No. 34035-Z dated JULY 2, 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 ACCESSORY SHED AS APPLIED FOR. The certificate is issued to ELIZABETH MARTINSEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMenT OF HEALTH APPRO%rAL ELECTRICAL CERTIFICATE NO. PLUMBERS c~TIFICATION DA'r~u3 N/A N/A Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANI This application must be filled in by typewriter or ink and submitted to the Building Dep, A. For new building or new use: I. Final survey of property with aocurate location of all buildings, property lines, stt topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 fo~ 3. Approval of electrical installation from Board of Fire Underwriters. 4. 5. ets, ~_~unusual natm"~l ctr 1 BLDG. DEPT. TOWN OF $OUTlqOLO Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 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 prope~y 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, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pm-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: Location of Property: ,.~ 7 5 House No. Owner or Owners of Property: Old or Pre-existing Buildin*d: / (check one) Street Haml~ Suffolk County Tax Map No 1000, Section Subdivision PermitNo. ~lJ03~ 2 DateofPermit. +~&--Oq ! Health Dept. Approval: Block ot-oo Filed Map. Applicant: Lot 0~0 oeo Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Underwriters Approval: Final Certificate: (check one) . 'Applicant ~gn-'~ure -- 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) PEP, MIT NO. 34035 Z Date JULY 2, 2008 Permission is hereby granted to: for : ELIZABETH MARTINSEN 275 HENRY'S LA PECONIC,NY 11958 "AS BUILT" ACCESSORY SHED AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 074 pursuant to application dated JUNE Building Inspector to expire on JANUARY 275 HENRY'S LA PECONIC Block 0001 Lot No. 020 19, 2008 and approved by the 2, 2010. Fee $ 200.00 / Authorl zed Signature / ORIGIN~kL Rev. 5/8/02 ¥o3_5-' ? ~ 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: INSPECTOR DATE ROUG~ FRAMING & tm PLUiV~ING , STATE ENERGY CODE J ~DITION~ CO~S : TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined '"~qoq''''- ,20 ~ Approved 7 /~,20_ ~" Disapproved a/c Expiration PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health Planmng Board approval Su ,ey Check ,~/90 . C~O Septic Form N.Y.S.D.E.C. Trustees Flood Pem~it Storm-Water Assessment Form Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,200 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 name, ifa corporation) (Mailing address of applicanD State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~'{..-17~tl~ ~ it~}~'~ (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. House Number Street County Tax Map No. 1000 Section "?~" Block Subdivision Hamlet l Lot Filed Map No. Lot 2. State existing use and occupancy of premises and intendedkuse and occupancy of proposed construction: a. Existing use and occupancy ~'~'lt~/~ ,~P'i/~ b. Intended use and occupancy Nature of work (check which applicable): New Building_ Repair Removal Demolition Estimated Cost If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work ~)f'll'~,,~r~ J~,kt~:~¢~ (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. I 2."ff"' 12. '/ 7. Dimensions ofe,xisfl, ing structures, if any: Front Rear Height } ~/~ Number of Stories I 9. Size of lot: Front 10. Date of Purchase It/'l Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Dimensions of entire new construction: Front Rear Height Number of Stories 133. 3 " Rear I I Z.. 7'¢ " Depth / Name of Former Owner ~"~OrJ'~P(~ Rear Depth Depth 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO__ l 3. Will lot be re-graded? YES NO I¢' Will excess fill be removed from premises? YES 14. Names of Owner of premises (~Pt~l~ltqJ'~'~ Name of Architect Name of Contractor Address t'~t~ Phone No. Address Phone No Address Phone 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 BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 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. 18. Are there any covenants and restrictions with respect to this property? * YES__ NO ¢X~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) ~~_~¢~J --,~ ~~ being duly sworn, deposes and says th~0~c.c~.slt~pplicant (Name of individual signing contract) above named, Notap/.Public, State of New ¥0dt t~o. 01BU6185050 A..~t~' O,,al,ied in S~01k Count~ ,r-. Commission ['mires Anri114. ~O/~~-- (S)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 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. Sws~t°~ef°~ea~;~his~ 20 ~ ~ Notary Public ~of Applicant ?~_ Z/_/__/__.~ TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET '~'7 '~) VILLAGE DIST? SUB. LOT ~om~ow~E~ ~ . EO , ~c~. ~ ~, J ~ ~ W ~PE OF BUILDING R~. S~S. VL. ~// FARM CO~. CB. MIC5. Mkt. V~lu~ ~ND IMP. TOTAL DATE RE~RKS Q . AGE BUILDING CONDITION N~ NOR~L BELOW ABOVE FA~ Acre Value Per Value Ac re Tillable FRONTAGE ON WATER W~lend FRONTAGE ON ROAD ~ M~d~l~d DEPTH ~ Hou~ Plot BULKH~D Total J DOCK COLOR TRIM M. Bldg. Extension Extension Extension Foundation Porch Basement Porch Ext. Walls Bath Floors Interior Finish Breezeway Fire Place Heat G~rage Type Roof Rooms 1st Floor Patio Recreation Room Dormer Oo Total Rooms 2nd Floor Driveway Dinette DR. BR. FIN. B Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: District 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) Ye~s 1 2 3 4 5 6 7 8 9 Will this Project Retain All Storm-Water Run-Off Generated by a Two (21') Inch Rainfall on Site? (This item will include all mn-off created by site clearing and/or construction activities as well as all Site [mprovements and the permanent creation of impervious surfaces,) Does the Site Plan and/or Survey Show ^ri Proposed Drainage Structures Indicating Size & Location? This item sharl include all Proposed Grade Changes and Slopes Controlling Surface WaterFIowI 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? 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 Si[e? 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) fee[ of Vertical Rise to One Hundred (100') of Horizontal Distance? Will Ddveways, 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 or 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 Building Permifl EXEMPTION: Ye~s No 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 Requiredl __ __ STATE OF NEW YORK, COUNTY OF ........................................... SS (Name of Jnflividua signing Do=ment) ~NNIE D (Owner, Contractor, Agent, Co.orate Officer, etc) Owner and/or represen~dve of d)e Owner of O~mer's, m~d is duly aufl~orized to perform or have performed fl)e s~d work ~d to m~e ~d file tNs application; ~at ~1 smtemen/s confined in ~is appficadon are line to ~e best of his ~owledge mid belief; ~d ~at ~e work will be performed in fl~e mm~ner set for~ in ~e applicadon filed herewilh. Sworn to before me tiffs; .............. ................ t ' NO~r Public: ...Qa~.~..-.....~.......~..~.....~... FORM - 06/07 Survey for: ELIZABETH MAR TINSEN LoC 3, "Map of Peeo~ie Homes" Pecor~ic Town of $o~h.o/.d. Suffolk County, New York S.C.T.M.: 1000-074.00- 01.00- 020.000 NOTES: 1, AREA = 21,g10 S,F, 2, · = MONUMENT FOUND, · = PIPE FOUND. .3. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON OCT. 14, 1964 AS FILE NO, 4181. 4, REFERENCE DEEO: L 10761, CP 216, SEPT. 07. 1999 AMENDED CER~FICA]~ONS DATE: SEPT. 01, lgg9 SCALE: 1"=.30' JOB NO: 99-0151 CERTIFIED TO: ELIZABETH MARTINSEN CHICAGO TITLE INSURANCE COMPANY OAV1D H. FOX N.Y.S.L.S. #50254 PO BOX 224 SPEONK. N.Y. 11972 (516) .325-2902 OWG: 990151