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34448-Z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-33949 Date: 09/15/09 THIS CEi~TIFIES that the building ADDITIONS Location of Property: 780 PRIVATE RD ~17 (HOUSE NO.) County Tax Map No. 473889 Section 81 Subdivision SOUTHOLD (STREET) (HAMLET) Block 3 I~)t 27.1 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 23, 2009 pursuant to which Building ~r~t NO. 34448-Z dat~ FEBRUARY 23, 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 TERRACE ADDITION, WITH IN GROUND SWIMMING POOL AND SPA, TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to LINDA S SANFORD (OWNER) of the aforesaid building. SUFFOLK ~I~N~TYDEPAR~TOF }~J~{APPROV~J~ N/A ELEt-£KICAL CERTIFICATE NO. 4002395 09/22/08 ~L~ERS CERTIFICATION D~r~u3 N/A Rev. 1/81 lgorm No. 6 TOWN OF SOWrHOLD BU1LDINGDEPARTMENT TOWN HALL ' ,: BLDG· DE.PT. - . IL For existing buiMJn~ (prior to April 9, 19S~) nOn-COnforming m~,m' buBdlngs and .pre-~xisflng'~ land. uses: fe~mre~. 2. A:.propedy COmPl,~axi 'application-and ~o%mit to h~spect ~ by the applicanL If a ~cate of Occupancy.is d~nied, the Building I~pector s~,l'stat~ the. ~ therefor in writing, to. the applicant. C. Fees " L Certificate'of Ocoapancy L N~v dwdlini$25,00, Additions to dwelling $25.00, Altcmtion~ to dwelling $25.00, Swlmmln~ pOOl $25.00, A~c~so~y building. $25.00, Additions to a~s~ry building $25.00, BusineSSes $50.00. 2, Certificat~ofOccupancyOnpr~-exis~ingBuilding.- $100~00 3. Copy ofO~ificat~ofO~upan~y - $;25 4~' Ul~lat~l'Ce~tific, at~ ofO~upancy- $50L00 5, Ti~nporary Ce~ificate of ~ - Resideg~d $15.00, Commercial $15.00 Constructi°n: ~/ O~d or Pre~oxi~dng Building. Date. ' ' ' (check One) H~lth Dept. Approval: Planning Board' Approval: . '. Request fo~. Temporary Certificate Fee Submitted: $ r~ fA) Underwfite~ Approval: Fina~ Certifidate: v/ (check one) Applicant Sjgaature BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FlEE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 ~,~. CERTIFIES THAT Upon the application of upon premises owned by G & S ELECTRICAL CONTR. LIND^ SANFORD P.O. BOX 215 PARADISE POINT RD. SOUTHOLD, NY 11971, SOUTHOLD, NY 11971 PARADISE POINT RD. SOUTHOLD, NY 11971 Located at Application Number: 4692395 Certificate Number: 4002395 Section: Block: Lot: Building Permit: . BDC: ns11 Described as a Swimming Pool occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Outside, Pool/Spa, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the ZZnd Day of Selnml.r, Name QTY Rate Rating Circuits Typ~ Appliances and Accessories Pool / Spa Bonding 1 0 Pool Heater 2 0 Gas Panels I ao I 100 7 I 60 7 Wiring And Devices Fixture 3 0 pool Incandescent GFCI Circuit Breaker 2 0 pool Receptacle 20a-pool Special / twist lock 8 0 (Swimming Pool): This certificate covers compliance at thc date of inspection only. Because of unusual environments it is advisable to have Frequent test andJor repairs made by a qualified person. seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BuILnING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34448 Z Date FEBRUARY 23,.2009 Permission is hereby granted to: LINDA S SANFORD 5 MOUNTAIN PEAK ROAD CHAPPAQUA, NY 10514 for : a~~ RAISED TERRACE AND IN-GROUND SWIMMING POOL ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at County Tax Map No. 473889 Section 081 pursuant to application dated FEBRUARY Building Inspector to expire on AUGUST Fee $ 494.00 780 PRIVATE RD #17 SOUTHOLD Block 0003 Lot No. 027. 001 23, 2009 a_~d approved by the 23, 2010. ~ized ~ ORIGINAL Rev. 5/8/02 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Halt Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PE~{MIT NO. 33645 Z Date JANUARY 24~ 2008 Permission is hereby granted to: LINDA S SANFORD 5 MOUNTAIN PEAK ROAD CHAPPAQUA, NY 10514 for : ONE FAMILY DWELLING AS APPLIED FOR PER ZBAr DEC AND TRUSTEES. THIS PERMIT REPLACES BP 30762. at premises located at County Tax Map No. 473889 Section 081 pursuant to application dated JANUARY Building Inspector to e-~l~ire on JULY Fee $ 4~043.40 780 PRIVATE RD #17 SOUTHOLD Block 0003 Lot No. 027.001 24, 2008 and approved by the 24, 2009. .<-...: ,?/, ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] II~LATION [ ~/FFINAL ~ [ ] FIRE SAFETY INSPECTION [ ]RRERESISTANTCONSTRUCTION [ ]FIRERESISTANTPEhc,.ATION REMARKS: ~/~J ~ ~ DATE INSPECTOR FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING -- INS~ATION PER N. Y. STATE ENERGY CODE ~DITION~ COMMENTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD~ NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined ,20__ Approved -'-~/2~ 20__ Disapproved a/k Expiration ,20 FEB 12 2OO9 BLDG. DEPT. TOWN OF $OUTHOLD BUILDING PERMIT APPLICATION CHECKLIST PERMIT But~g Inspector 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 Permit Storm-Water Assessment Form Contact: Mail to: Phone: aPPLICATION FOR BUILDING PERMIT Date Fo_ ¢9, ~ Z_ ,20 0 q 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 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 author/zed inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) (Ma ling address of applicant) /~c( Ilk"/I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~ ~c~ ~ (As on the tax roll or latest deed) If applica[t~s a co¢orati%n, si~ature of duly au~ofized officer (Wame and title of co¢orate officdr) Builders License No. Plumbers License No. ElectficiansLicenseNo. Other Trade's License No. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section 0a I Block ~o Lot 52 ?. oo { Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy at, e_ xco-cr, ,[~ d,,o e..[[,~ ~1- b. Intended use and Occupancy 0 r~ ~ 4 cu~,~, ~.~ d l ~¢~ \' ~ ~) 3. Nature of work (check which applicable): New Building_ Addition Repair Removal Demolition Other Work 4. Estimated Cost ~[~Ot {/~ Fee 5. If dwelling, number of dwelling units If garage, number of cars ,( co,¢mr~ ~ ?ool Alteration (D~sc~iption) (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 Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear 8. Dimensions of entire new construction: Front Rear .Depth Height Number of Stories 9. Size of lot: Front I~/'~ Rear ~'-I? _Depth 10. Date of Purchase 9 -I q - o 2. Name of Former Owner 'flare- 11. Zone or use district in which premises are situated t~- oc'O 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 7 13. Will lot be re-graded? YES NO__Will excess fill be removed from premises? YES __ NO__ 14. NamesofOwnerofpremises [_~g~c~.l'o~%rd., AddressS',qlo,~-,o2~o-zlf~Phonelqo. c~¥-230c'-g761 NameofArchitect ~h~'-Iq¥ /!dtx.rgol, Address/~,Ig)u~to, ,,~,d- PhoneNo cJl~-23g-3'4cto Name of Contractor 'JTh r~ t~c,4o.a,' ~kL¢ ~4c--Address 0d~2~t~~one No. ?or4c ¥ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES v/ NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS,MAY BE REQUIRED. ObYmt rv~ b. Is this property within 300 feet of a tidal wetland? * YES v' NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. Bo~ -~&~-,~&,&~o,x.Z- 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 v/' · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ,~.-{ ~Bc-) ~.~c~d~- ('3. ~'~ e..r--k-c~', 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 I 2- day of ~"~...k2 20 c)c~ · N~fm'v ~thlin ~N~ Notaw Publi~ ~ ' No. 01~0619~96 ~ upal~ in S~k ~u~ ~mmts~ion ~pir~ July Signature of Applicant Town of Southold t Erosion, Sedimentation & Storm-Water Run.c I~-~S~E _~SI~E~IT~F~RI DM~ S~n B~k LM C~ ~r~ED BY A DESIGN PRO~i It~ Num~ (NO~: A ~ Ma~ (~) f~ ea~ OuesU~ is R~u~ f~ a ~m~ete ~i~n BLDG. DEPT. 1 ~11 ~b Pm~ Re~in NI St~Water ~n~ff Ge~t~ by a T~ (2") In~ R~nfall ~ Site? 2 D~; ~e site Plan ~ Suwey Sh~ NI Pm~s~ D~na~ S~s Indi~fl~ S~e & L~fi~? ~ls I~m s~ll Include all P~ Grade Changes a~ S~ C~li~ Su~ Wat~ 3 ~l ~ls Pmje~ R~ulm any Land Filling, Grading or ~U~ ~em ~em ~isting Grade Invol~ng ~m ~an 200 Cub~ Ya~s of Matedal ~in any Pamel? 4 ~11 ~is ~l~ R~uim L~d ~stu~ng A~es En~mpassi~ an ~ea Rye ~nd (5,~0) Square F~t ~ G~ Su~? 5 Is ~em a Natural Water ~ume Ruling ~m~h ~e Site? Is lhis Pmj~ ~in ~e Trustees juHsdiction or ~thin One Hundred (1~') feet of a Wet and or Beach? 6 Will ~em be Site pmpamUon on E~sting Grade Slopes ~i~ ~c~d Fi~een (15) feet of Ve~l Rise to One Hund~ (100') of Ho~on~l Dis~n~? 7 ~ll Driveways. Pa~ing ~as or other Imperious Suda~s be Slop~ to Direct Sto~-Water RunOff into and/or in ~e direc~ of a To~ ~ghtmf-way? 8 ~ll ~is P~ R~uim ~e Placement of Matedal~ Re~val of V~etation ancot ~e C~s~cfion of a~y Item ~in the To~ R ght~f-Way or Road S~ulder ~ea? ~hls Item will NOT include the Ins~llation of DHveway Aprons.) 9 Wi;l ~is Pr~e~ Require Site Preparation within the One Hund~ (100) Year Fl~plain of any Water~e? NOTE: If Any Answer to Questions One through Nine is Answered with a Check Ma~ In the Box, a Sto~-Wa~er, Drainage & Erosion Control Plan Is Required and Must be Submi~ed for Review Prior to issuance of Any Building ~MPTION: D~s ~is ~e~ meet ~e minimum s~ndards f~ dassifl~Uon as an A;~ltuml Project? Note: If You Answered Yes to this ~estlon, a Sto~-Water, Grading, D~lnage & Erosion Control Plan Is NOT Requlmdl CO~ O~cr ~Wor rcpr~cn~dvc o~ ~e ~ncr o[ O~cr%, ~d is duly ~u~o~cd to ~c ~d EE ~s appl~on; ~t ~1 s~tcmcn~ con'ned in ~ appU~don ~m ~c to ~t ~ ~rk will ~ per[orated i~ ~c m~ncr set [o~ in ~ appJicadon filed Sworn m ~forc mc ~is; FORM - 06/07 Commission E~ )..~.'~ TOWN OF SOUTHOLD PROPERTY CARD _ _ OWNER STREET '~ <~) VILLAGE ' DIST, SUB. LOT ~,~~ ~, Sq ,. W ~ ~PE OF BUILDING /~ ~S..~ O~ S~S. VL ' FA~ COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE REMARKS ~"~ ~ ~ ~ ~/~ " ;~" :~ ' <,._..= , , ,. , ~ ,,,,., liable 3 ~dland ~ampland FRONTAG~ ON WATER - ~ .~:'~ ~ rc ~.~ - ~shland F~., ~ ...... ,use Plot D~PTH /~: ~ ~ ~ ~ ~ BULKH~D ~ $ ral D~K RES, SEAS. VL ~ 'FARM CO ~/~V~,, CB. MICS.. ' MktJ Value LAND IMP. 'I:OTAL DATE REMARKS 'ill .. · · . - .' " ' ' ' ~ooctlaml. ·. ,,. , FRONTAGE' ON. ROAD-'- " ' ' DEPTH TRIM 81.-3-27.1 view from street 3/08 Ilomh Oo B. Basement ~u~.~ - Floors Ext. Walls $7~OAJ ~ Interior Finish Fire Place Heat Roof Rooms Ist Floor metion Room Roorm 2nd Floor ~.~-~ Driveway Nathan Taft Corwin El Land ~urvayor MASTER PLAN SKETCH SANFORD RESIDENCE v/ ,i ~:; 'JR!TERS CERTIFICAT~ REQUIRED L' OF OC' ,,JFW%Y PPROVED :"S NOTIFY BU~LDi'qG" : RTNENT AT 765-1802 8A'q 70 , ?',¢ FOR THE FOLLOWING !NSPEC?tONS: 1. FCUNDAT/CN - TWO REQUIRED FOR POURED CONCRETE 2. : 'H - Fi~:?''3 ~ PLUMBING 3. ,X BE COLFL2 { ' , SO. ALL CO[X:TRU' ; Pj Si:.uL MEET THE REQU~Rh, :::TU O; '[i-;E cODES OF NEW YORK S],,.~E. NDF [:'..5FONS~BLE FuR DESIG~i OR CONSTRUCTION ERRORS. RETAIN STORM WATER RUIX PURSUANT TO CHAPTER 23 OF THE TOWN CODE. Ji Dm Charles A. Napoli, Architect ~ Linda Sanford © . & 'j CODES Ci iA:--~ ER 46" iE PREVENTION WN ,~,O[ E. FF · 10/4/2004 3:19:03 PM