HomeMy WebLinkAbout34636-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33848 Date: 07/23/09
THIS CERTIFIES that the building ALTERATIONS
Location of Property: 115 EAST SIDE AVE MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map NO. 473889 Section 99 Block 3 Lot 19
Subdivision Filed Map NO. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 24, 2009 purs%u~nt to which
Building Permit No. 34636-Z dated APRIL 28, 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 GAS STOVE AND REPLACE WINDOWS AND DOORS IN AN EXISTING ACCESSORY COTTAGE
AS APPLIED FOR.
The certificate is issued to 343 EAST 18 LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUN~TYDEPA~TNENTOF~EALTHAPPROV~J~
EI~t-rKICAL C~KTIFICATE NO.
PLUMBERS CERTIFICATION DA'r~D
N/A
N/A
N/A
Rev. 1/81
TOWN OF SOUTHOLD
BUH~DI~GDEPAR~
TOWN HALL
765-1802
?
APPLICATION'FOR CERTIFICATE OF occUPANCY
· -This. application must be filled.in by ~t~- or ink and submitted to tim. Building
A. For new buil&i%o or'new use:
-1.. FinS1 surly of p~ with ac~m~te 10ca4ion of all buil~%os, p~ lines~ .uu c~ts, and un ,u~usl natural or
~ :Iqnal Approval ~ Heat~ Dept o~iwster.suPPly ~! sewerage-dispom(S-9 form).
-. ~. ~val ofetectdc~l.'"mstal~/on .~0;~ B0~°fl~'Unaer°nite~
5..Com~ buflding~ in~ buildings-multiple i-czidenees.~nd sim~tar b~.ln~ anffinstallations,.a certificate
- B. For exJst~'build~ngs (prior to. Apt~! 9, 1957) n0n-eonf0rmlng uses,.~r.buildings and ,pre-exisfin~'~.!and. useS:
1. ' Aomrat~ s'tt~Y ofp~ ~hbwing all property.lines~ street~.buildixig and.unusual, natural or topographic
f~.
Z P~.pr6perly c0mpieted*appt~catiotiand e0nseat to inspect s~gned by the applicant. If a Certificate of oCCUPaucyis
defiiccl, the Building Inspector st/all:state th~ reasons thc~ef0r in writing to ghc applicant.
C. Fees
' -L, Cerfificat~'of'Occupanoy- NoW fiwelling$25,00~ Additions to dwelling $25.00, Alterations to dweBing $25;00~
Swimmin§ pool $25~00, Accessory buildi;xg $25.00, Additions to accessory building ~O.5.00, BusinesSeS $50.00.
Certificate of Occupancy On Pre-existing Building- $100.00
3. Cop3(ofCerfificateofOc~.upancy d $~25
updated. C~tificate o f OccupanCy -. $50~00
Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Dato.
- New.Construction:.. "' Ok~ ;i' Pre-existing Building:.: .~/7 .
.... HoUSe No .... Street
.owner or OwnersofPtopert~ ~qg.~.s~ l°o'/-t-~ .
' 8uiXiivision . Filed Map.'.
permirNo..'~_fo ~ ~-'-~DateofPermit , Appl!Cant:
Health Dept. Approvall k) -J~ .. Underwriters Approval:
· Planning 8oard Approval: , ,'N /~
Finai Certificate:
Rexluest for: Temporary C?tificate
Fee Submitted: $
Hamlet
9.%
(check one)
~Appli~tr t ~igna~u~~
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUIDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 34636 Z Date APRIL 28, 2009
Permission is hereby granted to:
343 EAST 18 LLC C/O LOWRY
441 HAWTHORNE PLACE
RIDGEWOOD,NJ 07450
for :
REPLACE THE WINDOWS & DOORS AND INSTALL GAS STOVE (PER MANUFACTURE
SPECS) IN EXISTING ACCESSORY COTTAGE AS APPLIED FOR.
at premises located at
County Tax Map No. 473889 Section 099
pursuant to application dated APRIL
Building Inspector to expire on OCTOBER
115 EAST SIDE AVE MATTITUCK
Block 0003 Lot No. 019
24, 2009 and approved by the
28, 2010~
Fee $ 100.00
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:
DATE
INSPECTOR __~' ~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
FOUNDATION 1ST
FOUNDATION 2ND
[ ] ROUGH PLBG.
~INSULATION
~ STRAPPING
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
] FiRE RESISTANT PENETRATION
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION [
REMARKS:
DATE
iNSPECTOR ~/~ ~/~~'-
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH F~G &
PL~G
STATE ENERGY CODE
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TOWN OF SOUTHOLD
BUILDING DEPARt .SMENT
TOWN HALL °
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
Approved
Disapproved a/c
Expiration
BLDG. DEPI.
a Thi~ ff{Jll~f0fifi0ttll~HllST be col
sets of flans, accurate plot plan to scale.
PERMIT NO.
BUILDING PERMIT APPLICATION CtlECKLIb.
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survex
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Storm-Water Assessment Form
Contact:
Mail to: L4 t~ I ~:1.~' ~ ?}.
Phone: ~[ 0 ~ - c~gO -"710g
Building Inspector
'PLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20 (39.
tpletely filled in by typewriter orin ink and submitted to the Building Inspector with 4
~ee 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.
' "' -" UNDERWRITERSOERT FIC
.., Y' Olq
tS U AWI-UL
WITHOUT CERTIFICATk;
s O.F OCCUPANCY
tate whether apphcant is owner, lessee,
(Signature ~r name, ifa corporation)
(Mailing address of applicant)
agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises all3 ~,,~- I% /..-CC._ &h4 ¥Cf'Ah°fi:
(As on the tax roll or. est deed)
If applic~t is a co~oration, si~ature of duly authorized officer ~'~'~:--'~:
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians LicenseNo.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street
NOTIFY E, UiLD; ,~, Li:;:L,-NT AT
765-1802 8AM T:) ,:';~ FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POU,qED CO/',CRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
~R~E~S OF THE CODES OF NEW
~ ~Tff.' NOT RESPONRIRI g FQR
B~I~ CONSTRUCTION ERRORS.
County Tax Map No. 1000 Section
Subdivision
Block ,,. ,¢--~ "' ,,, Lot I o~
Filed Map. No. ,. , Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair ~ Removal Demolition
4. Estimated Cost 5~t. Jrt 6o~o '~''
5. If dwelling, number of dwelling units l
If garage, number of cars
Addition Alteration
Other Work ~,l,t,~ ~.,l~.~,d~ ~ ~*~ I~&'tl,.
(Description)
Fee
(To be paid on filing this application)
Number of dwelling units on each floor I
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front .2~' q"
Height 1 5 Number of Stories ~
Rear ~, ,' t~" .Depth ~,' ~4"
Height
9. Sizeoflot: Front lob
10. Date of Purchase
Dimensions of same structure with alterations or additions: Front
Depth 3x~~ q" Height ~ g
Dimensions of entire new construction: Front ~"
Number of Stories --fi--
Rear 50
Name of Former Owner
zo, . ,],,,,,~ ,,.. e -
Number of: Stbdes ,
_Depth ~[ o ~i~_:'~5
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 Y' Will excess fill be removed from premises? YES NO
14. Names of Owner of premises~5 ~ Address~-,a~,~o,A ~;X o"/~S0 Phone No.
Name of Architect 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 of a tidal wetland? * YES ~ NO__
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, w~th accurate foundation plan and &staffces 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__
· IF YES, PROVIDE A COPY.
NO ~
STATE OF NEW YORK)
SS:
COUNTY Ol~tlf--('-O~. )
~ C:(~t,¥ ,~0 ~2> C~k.,~J~ - being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contraO0"above named,
(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.
.~,~ to befo~ea~n~;his/,3NOC/~
~pplicant
I ,2 3 4 5 67'7 8 9 10 11 12 13 14 15 16 17
~ I ~ ~ I~-'~ "- ~-~ ~'-m --
'lO
17
~0
26
19 20
lq'
-~-o.,.;,,,,,~ ~o-V ~ -~-~,~
Lowry
115 East Side Ave.
Mattituck
TOWN OF SOUTHOLD pROPERTY RECORD CARD
0,~00
TYPE OF BUILDING
/'
OWNER DISTRICT SUB.
FORMER OWNER N -- E ~/ , ACREAGE
~ND ~ IMP. TOTAL DATE REMARKS
/.z o o ~$ aa
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
Farm Acre Value Per Acre Value
Tillable 1
Tillable 2
Tillable, 3
Woodland
Swampland
Brushland
House Plot
Total
Foundation
Basement
Ext. Walls
Fire Place
c~6 X' /~ Porch
Porch
Patio
Driveway
Bath
Floors
Interior Finish
Heat
Attic
Rooms 1st Floor
Rooms 2nd Floor
TOWN OF SOUTHOLD PROPERTY RECORD CARD
~ STREET VILLAGE DIST. SUB, LOT
ACR. REMARKS
TYPE OF BLD.
PROP. CLASS
LAND IMP. TOTAL DATE
FRONTAGE ON WATER HOUSE/LOT
BULKHEAD
TOTAL
COI.OF
TRIM
M. BIog. I~...~'' ~o~q'~7 ~'/~c~{~- Foundation ~ CB
~ OTHER Bath ~ Dinette
Extensl°n ~O ~.~0 ~ Basement s~%w~ ,~,~ Floors ~ Kit'
~ ~O ~O = ~ ~ ~ /~ Finished B. ~ Interior Finish ~ L.R.
Extension Fire Place / ~. Heat ~ D,R,
Garage ~' l.~5 ~ Ext- Walls BR.
P°rch~ ~x~= I ~ ' , ~0 ~ Dormer Baths
P°°I~m ~ P O~ ~ O~ Foyer
O.B. Libm~/
Dock~{O~ ~~) I~=?~ .~ / ~ Study
1st 2nd
TOWN OF SOUTHOLD PROPER~
STREET
VILLA
IMP.
ACR.
REMARKS
TYPE OF BLD.
PRO~ CLASs
TOTAL DATE
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Andersen Windows and Patio Doors I New Construction Windows I Replacement Windo... Paee 2 of 3
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Criteria Allowed
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Size · 47" x
Glass Type U-Factor SHGC VT
Clear Dual Pane 0.47 0.60 0.63
Clear Dual Pane with Grilles 0.47 0.54 0.56
0.30 0.32 l?
N NC
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This data is accurate as of November 4, 2008 Due to ongoing product changes, updated test results,
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Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M. ~h
Distdct Section Block Lot
THE FOIl. OWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER~ GRADINGr DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFE881ONAL IN THE STATE OF NEW YORK.
Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application)
Ye__s N._.~o
1
2
3
4
5
6
7
8
9
Witi this Pmject 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 inlpervious sudacas.)
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 WaterFIowi
Witi this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural
Existing Grade Involving mom 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 Coume Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a ~/Ve and or Beach?
Witi there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15)feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
Witi Driveways1 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 Vege~tion and/or the Construction of
any Item Within the Town Right-of-Way or Road Shoulder Araa?
(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 Waterconme?
NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mad< 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:
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 Requlredl
Yes No
That I, .~..~.,.~: ...................... ... ~ duly sworn, d~ses md rays ~at he/she is ~e appoint for Perish
~d ~at he/she is ~e
O~cr ~n~or rcpmscn~dvc
m~c ~ file ~s ~pplicadon;
~at ~e work wi~ be peffom]ed in ~e m~ner set fo~ in ~e application filed here~.
Sworn to before me this;
...... ......... ->5- ............. aayof ..... : .....................
? .... ""~'::.:'~'~'"" f '"'"~ r ~ ............................
/ <_.J
FORM-/06/07 o~,.s~,~c,~,,~ 0.,--,~:~
343 East 18 LLC
Andrew Lowry
441 Hawthorne Place
Ridgewood, NJ 07450
201-670-9472
Cell 201-960-7306
April 23, 2009
Building Permits Examiner
Southold Town Hall
53095 Main Rd.
P.O. Box 1179
Southold, NY 11971-1179
Re: 115 East Side Ave. Mattituck - Cottage Repairs
This accompanies a Permit Application and describes in more detail the work planned.
Essentially, I am requesting permission to replace the existing windows, doors and gas
heater.
1. Replace all existing (8) windows with new Anderson Series 200 windows which
are the same size (3'x 5') and in the same location as the existing windows. The
two windows in the bathroom will be tempered glass. Storm panels will be cut
and on site for inspection.
2. Replace the 2 existing doors with new Thermatm or Anderson doors which are
the same size (3'x 6'8") and in the same location as the existing doors. New
doors will have glass panes halfway down the door.
3. Replace the existing propane beater in living area with a new Vermont Castings
Stardance gas Stove (direct vent rear). The stove will be seated on a non-
combustible hearth. Specifications for the stove are attached.
5t)RVE¥ OF: PART OF LOT 2
HAP OF: OLD HILL HAVEN C.,O.
FILE~ OCTO~R 2, Iq25 FIL~ No.
SITUATE.' HATTI'TI,~I<
TOI,~N .' .GcK,rTHOLg
5UI=FOLK C, OUNTY, N'f'
5URME'Cffi2 0q-2q-2004
AI'dEN~ED 12-10-2004
5EFq'IO ADDED 02-C:Xt-2005, 04-15-:;'005
k~-TLAND REVISION
PROP~D AGTION50~,-12-2OC~,
12-DO-2OO5, I-D-2OO~, O1-11-2OO~
LOT C, OVL=RAG-E O2-1.5-2OO~, O2-10-2OO-/
FOUNDATION LOGATION Oq--O..5-2OO"/
FINAL 5URVE'¢ O1-12-2OOq
SUFFOLK COUN'F'¢ TAX #
IOOO-qq-:~-Iq
5t.IFFOLK. COUNTT' DEPT. OF HEALTH
5E-RVIC, E5 REP, # RIO - 05 - 0201
ANDR.L:r~
- T~6m_o2,~,,w
NOTES:
· h'IONUHENT FOUND
D~.'f'INDLL5 INSTALLED ARE ~,' DIAI'IET'ER BY 8¢ DEIEP
PEEP REFERENC, E LIBER ,558,2 PA~E Oq
FIRH FLOOD ZONE5 REFERENC, E MAP ~f;,Io~(.,OI4~ ~ DATED HAT 4, Iqq8~
AREA TO TIE LINE IN DEED -- I-/,-/24 5.F. or 0.4l AC, RE
AREA INC, LbrDIN~ IRREC~ULAR C, URV~S = 21~-/q 5.F:. or 0.4q AC, RE
®P-.APHID ~C-,ALE I'l= ~O'
N
I
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF.-\\Compaqserver~os\04\04-278C.pro