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HomeMy WebLinkAbout34700-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-33906 Date: 08/18/09 THIS u~KTIFIES that the building ADDITION Location of Property: 5535 OLD NORTH RD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 51 Block 3 Lot 6.2 subdivision Filed Map NO. Lot NO. SOUTHOLD conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 11, 2009 purs,,~nt to which Building Permit NO. 34700-Z dated MAY 21, 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 The certificate is issued to ALBINA SAWICKI (OWNER) of the aforesaid building. Sum~OLK COD1F~Y DEPART~ENT OF HEALTH APPRO~-AL N/A ELECTRICAL ~U(TIFICATE NO. 8837 06/21/09 PL~EI~S u~K'~IFICATION DA'r~J N/A Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW31 HALL 765--1802 APPLICATION FOR CERTIFICATE OF OCCUPA This application must be filled in by typewriter or ink and sUbmitted to the Building De ~ t ...... , whn me t011owing: A. 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 froln plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Colmncrcial 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: l. Accurate survey of property showing ali 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 l. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinnning pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Busincsses $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 - Residenti&l $15.00, Commercial $15.00 New Construction: Location of Property: ~'~ '~ O~ House No. Owner or Owners of Property: ~ Suffolk County Tax Map No 1000, Section Old or Pre-existing Building: Date. (check one)~.....~.- Street Hamlet Block C)'-~ Lot Subdivision Permit No. Health Dept. Approval: Filed Map. Lot: l)ateofPernlit. ~Z.~--I~ Applicant."~'~_~tl~ Underwriters Approval: J Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~ ~ o~ Final Certificate: / (check one) Applicant Signature Nassau Suffolk Electrical Inspections,Inc. P.O. Box 549, Aquebogue, New York 4. 11931 Tel: 631-591-3097 Fax: 631-591-3098 Application: Issued to: Address: Village: 8837 Date: 6/21/09 Sawicki 5535 Old North Rd Introduced By: Big Blue Electric Southold Licenseg: 35348-ME Residential [] Commercial The following was examined and approved up to the above date and found to be in compliance with tho NEC: Attic 1st Floor [] 2nd Floor 3~ Floor Garage Conversion Basement Hot Tub Addition [] Detached Garage Pool Switches Receptacle Fixtures G.F.I. Microwave Hood Smoke Detectors 6 5 Fans Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Carbon Monoxide I-Paddle fan Furnace Oil Gas Heat Zones Whirlpool Exit Signs Limited Insp. ]] Final Insp. Meter Amps Phase Motors II 6/21/09 Other Equipment: i-Fan ContoL2-Dimmcrs, l-3 W'a3 Dimmer, l-3 V, ay Switch, l-Single Pole Switch This certificate must not be altered in any manner FORM NO. 3 TOWN OF SOUTMOLD 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. 34700 Z Date MAY 21, 2009 Permission is hereby ~ranted to: ALBINA SAWICKI 5535 OLD NORTH ROAD SOUTHOLD,NY 11971 for : CONSTRUCTION OF AN UNHEATED SUNROOM ADDITION TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 5535 OLDNORTH RD SOUTHOLD County Tax Map No. 473889 Section 051 Block 0003 Lot No. 006.002 pursuant to application dated MAY 11, 2009 and approved by the Building Inspector to expire on NOVEMBER 21, 2010. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 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 ] RRE RESISTANT PENETRATION REMARKS: DATE '~-~/-~0 7 INSPECTOR~ ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] RO~JGH 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 [ ] FOUND~K)N 1ST [ ] ROUGH PLBG. [ ] F/QUNDATION 2ND [ ] INSULATION [r~] FRAMING / STRAPPING [~ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~~ ~ - DATE ~-~///~/~ ~ INSPECTOR..~ ~ FI~,I,D ENSPECTION REPORT I DAT~ ] COMMENTS FOUNDATION (1ST) /"~'/ L ' / FOUNDATION (2~) ROUGH F~G & PL~G / / ~ - ~SULATION PER N. Y. STATE ENERGY CODE F~ ~DITION~ CO~ENTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined Approved Disapproved a/c 20_ Expiration , 2o/o PERMIT NO. / Building s'lh~ctor BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of I-Iealth 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: sets }lAY 11 2O09 a. Thi~t~I~UST bec plans, accurate plot plan [o scal~ APPLICATION FOR BUILDING PERMIT Date ~,_~ ----- '-I .,200~ INSTRUCTIONS ,mpletely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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. ThereaRer, 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 applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~2)~ } ~x)~ "~-'~ ~ t/O I ~k~ ~._~ I (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. ~F2..~_~q-- ~-~ Plumbers License No. Electricians License No. Other Trade's License No. Loc~.~fl~d~ which proposed work will be d. oneBe.~~_~ .-_- 0L'[-'''') [,,.JO~::~l'-Jc-[ ~..~,-), House Number Street County Tax Map No. 1000 Section Subdivision {Name) Hamlet Block ot' fo Filed Map No. ~ Lot State existing use and occupancy of premises and intended use and o~zc~ancy of~ro~osed construction' a. Existing use and occupancy ~----'31N ~ ~'" [-"~ I'q ~ L.M, ~___,.~-~3 ~ 13 ~ ' b. Intended use and occupancy ~'~-' ~ 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars k) [ ~q ' Addition ~ Alteration Other Work (Description) Fee (To be paid on filing this application) Number of dwelling units on each floor I If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front ~(oI 4 Rear 2.~ (:::)~ ~t- Height "Z_. I ' 0" Number of Stories Depth J q 'z_.-. 50 Dimensions of sa,m, e structure with alteratiops or additions: Front Depth 2~?/o Height ~.[ OI~ _ Number of Stories ] l/'z..--. Dimensions. o~[ qntjre new construction: Front i 4 ' {r'~ Rear Height [ ~'--[o" Number of Stories I Size of lot: Front Rear ! Depth 10. 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 NOv,' 13. Will lot be re-graded? YES __ NO ~,'~ill excess fill be removed from premises? YES NO¥~ 14. Names of Owner of premises Name of Archit~ct~o~ Name ofContracto~ L,j AddressS$3s o~-0 ~o~ f4~Phone No. '-~65- Z;ZS'o Address ~1~ c~ Phone No ~ B -54 ~$ Address ~ 0al-r~ l'u ~ Phone No. 7-.cl B - ~o (3~rO 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 ]~EQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES * 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. STATE OF NEW YORK) SS: COLrNTY OF ) '~'~,:~t~. ~k~, ~oi') ~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) 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. Sworn to before me this dayof ~ 200t~ [ Notary Public ~ - gign~mre of Ap~cant BARBARA H. TANDY Notary Public, State Of New Yo~ No. 01TA6086001 Qualified In Suffolk County Commission Expires 01/13/20 _J.J.. Town of $outhold 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. GRADINGr DRAINAGE A,ND EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE 8TATE OF NEW YORK. Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? Ye~s N_.~o 2 3 4 5 6 7 8 9 (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 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 Sul~aca WaterFIowl 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 Material within any Parcel? W/il 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 Site? 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) feet of Veal/cai Rise to One Hundred (100') of Horizontal Distance? 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? Will this Project Require the Placement of Matedal, Removal of Vegetaben 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 Watemourse? 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 permit! EXEMPTION: Does this project meet the minimum standards for classification as an Agricultural Project? Note: tt You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requlredl Yes No STATE OF NEW YORK, COUNTY OF ........................................... SS That I, ~<:~ ~ ..&.. ~ ...~..I..........~....~......~.'....~...... being duly sworn, de'poses and says that he/she is the applicant for Permit, (Name of individual signing Document) And that he/she is the ~_..,c,:..~tO ..T'..~.~..'~..(~ ~,- ...................................... (Owner. Contractor, Agent, Corporate Officer, etc.) Owner and/or representative of the Owner of Owner's, and is duly authorized to perform or have performed the said work and to make and file this application; that all staVements contained in fids application are uae to the best of his knowledge and belief; and that the work will be peffornmd in the manner set forth in the application filed herewith. Sworn to before me this; day of .......................... 20.(~.? Notary Public: ......... ~.~ ....................................... CrI~ARB;~R~: ." ^..,~'~" (s;~'fi;,t.re o}'~ ............... ~ Not~ Public, t~tate u~ ,~ rYNu' C.~TA$Cg~00~. FORM - 06/07 Qua fled In Suffolk County, I Commlseion Exp re,. 01113/20 .L~ (~' -~'~'OWN. OF SOUTHOLD PROPERTY RECORD CARD /~-~-- ~7- .z- ~ '"""' '"- .,,,,,,,,v.... . ~)WNER STREET g~-~ ~' 'VILLAGE DISTI SUB. LOT FOYER OWNER , . N E ~ ~ ~ ~ ~' ~ ~PE OF BUILDING, ~ES. ~/O S~S. VL FARM COMM. CB. MICS. Mkt. Volue N~ NOR~L BELOW ABOVE rilloble FRONTAGE 0 T R , N~land FRONTAGE ON ROAD ~eadowl~d DEPTH ~ - /~ ~ouse Plot BULKH~D fotal D~K :-COLOR TR'IM ~ M. Bldg. . Extension Extension Extension Porch Breezeway Garage Patio O, Bo Total Foundation Basement 70' Ext. Wa,s Fire Place Type Roof Recreation Room er Bath Floors lnteriot-Fihish Heat Rooms 1st Floor Rooms 2nd Floor Driveway KDinette ~,q,~., . LR. DR. BR, FIN. B /~-"74:::~::)'' ~t' ~"4",..~ 1 TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DISTT' SUB. LOT ACR. REMARKS TYPE OF BLD. · LAND IMP. .TOTAL DATE FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD .~,~ WOODLAND DEPTH J ~'"~'~ MEADOWLAND BULKHEAD HOUSE/LOT TOTAL COLOR TRIk,' M. Bldg. Foundation . c Bath Dinette CB FULL Extension Basement CRAWL Floors Kit. Extension Ext. Walls Interior Finish IL.R. Extension Fire Place Heat D.R. Patio , Woodstove BR. Porch Dormer Fin. B Deck Attic Breezeway Rooms 1st Floor Garage Driveway Rooms 2nd Floor Pool S 86'03'30"E CE) 158.00' FRAME GARAGE WOOD FRAME RESIDENCE (PROPOSED) N 86'05'30"W ~ WOOD DECK W/RAILiNG BRICK & SLATE STOOP & STEPS C) 158.0C OLD NORTH ROAD 0 W/BLOC~ Z PIPE SURVEY OF D£SCRIB£D PROP£RTY SITUATE SOUTHOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. GUARANTEED TO: AI_F?INA gAWk KI SURVEYED FOR: ALBINA SAWICKI TM# 1000 05~-05 006.2 SURVEYED: 13 APRIL 2009 SCALE 1"= 20' AREA - 26,860 OR 0617 ACRES SURVEYED BY STANLEY d. ISAKSEN, JR. P.O. BOX 294 N~EW S~FFOLF( N.Y. 11956 '~' NYS Lic~ No. 49273 ogR 718 ; ~ // ~ x ~' ' ~, ~ 765-1802 8AM TO 4 PM FOR THE 4. ,. ~, ~D ~.~ i~ -- J ~ . ~ ~ ~' i 2. ROUGH - FFAMINO & PLUMBING : ~YtSTl~ ~ 3'/~1'/~ ;'~.- ~o"~ ~ ~ 4. FINAL - CONSTRUCTION MUST / ~ ~ ~,~ ~ c~ ~ ~ ~'m Rm'~"' ALL CONSTRUCTION SHALL ME~ ~ ~ ~~ j ~ ~ Y ...... TATE: NOT RESPONSE ~ ['~ ' OCCUPANCY OR *~' ~ / ~ ~ ' ~- USE IS UNLAWFUL ~o0 ~ ~TIO~ pL~ L~'~ , , OFOCCUPANC~, ...... - ~:~ ........ ~ ": .............. ~, '~ ~'~L /~~ .......... , ........ =,~ q -----~ ,, COD ~ .................. ::- -_: ~,~-To ~t~v~ --~ --- ! ~ ~ ~C~ '---' ~' -~ - i -' , / ! ¢~ .... , / ! , IIH/I x F ' ! - ' :: il ........ .................. .~ L I '