HomeMy WebLinkAbout35044-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34006
Date: 10/13/09
THIS CERTIFIES that the building DECK ADDITION & ALT.
Location of Property: 520 OAK DR
(HOUSE NO.) (STREET)
Coualty Tax Map No. 473889 Section 80 Block 2
Subdivision
Filed Map NO. __ Lot No. __
SOUTHOLD
Lot 13
(HAMLET)
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 25, 2009 pursuant to which
Building Permit No. 35044-z dated OCTOBER 2, 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 "AS BUILT" DECK ADDITION & ALTERATION FOR HALF BATHROOM AS APPLIED FOR.
The certificate is issued to MARY JANE MENENDEZ RVC TR
(OWNER)
of the aforesaid building.
SuFfOLK COUNTY DEPARTMENTOFHEALTHAPPR0%r~J~
~T~-£KICAL C~KTIFICATH NO.
PLUMBERS ~TIFICATION DA'i-~U
N/A
N/A
or, zed Signature
Rev. 1/81
OCT 9 2009
B[DG. DEPT.. PLICA
TOWN OF SOUTHO,~r
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
'ION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
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 from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5. Commercial 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:
t. Accurate survey of property 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 Pre-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
New Construction:
Location of Property: ~ ~)
House No.
sO:nffff;°~oOunW:;r: °/PMr:;eN~oY1000,~S~ct~n~ ~
(check one)
Old or Pre-existing Building:
Street
Subdivision
Permit No. 3 3-C>
Health Dept. Approval:
Hamlet
Block & bt
Filed Map. Lot:
DateofPermit. ]C~ ] 2/ ] t~, Applicant: ,/~k-~/k~fl~ ~- / l
Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ L~. ~
Final Certificate:
Applicant Signature
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. 35044 Z
Date OCTOBER 2, 2009
Permission is hereby granted to:
MARY JANE MENENDEZ RVC TR
520 OAK DR
SOUTHOLD,NY 11971
for :
"AS BUILT" DECK ADDITION & POWDER ROOM ALTERATION TO EXISTING
DWELLING
at premises located at 520 OAK DR SOUTHOLD
County Tax Map No. 473889 Section 080 Block 0002 Lot No. 013
pursuant to application dated SEPTEMBER 25, 2009 and approved by the
Building Inspector to expire on APRIL 2, 2011.
Fee $ 400.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
] FOUNDATION 1ST
[ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [~-'F'I~'--
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
] FIRE RESISTANT CONSTRUCTION
REMARKS:
[ ] FIRE RESISTANT PENETRATION
DATE INSPECTO
Garrett A. Strang
Architect
1230 Traveler St., Box 1412
Southold, New York 11971
Telephone (631) 765-5455
Fax (631) 765-5490
September 25, 2009
Southold Town Building Department
Main Road
Southold, NY 11971
Re: Premises, 520 Oak Drive, Southold, NY
SCTM # 1000-80-02-131
BLDG. DEPT.
TOWN OF SOUTHOLD
Dear Sir or Madame,
I have personally visited the above referenced premises and reviewed the existing deck
which was partially constructed over an existing brick patio. I was able to observe the
deck structure and found it to be structurally sound and in good condition.
I have prepared and submitted "as built" drawings for both the deck and an interior powder
room which was created within the footprint of the existing house requiring no structural
modifications.
Based upon my observations, and structural analysis, it is my opinion that the deck, as
constructed, is structurally sound and in compliance with the New York State Building
Code (NYCRR) that was in effect at the time it was built.
I trust this satisfies your concems however, if you have any questions, please feel free to
contact my office.
Garrett A. Strang,
Architect.
~O~A~O~ (~S~)
, ROUGH ~G &
PL~G
~8~A~O~ PER N. Y.
STATE ~ CODE
.,
'
"
~D~ION~ COUNTS
~ m
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SouthoidTown.NorthFork.net
Examined /O/~---, 20 ?
Approved /4 ,7--~0 ~
Disapproved a/c
Expiration
/
20 //
PERMIT NO. ~5~ ~(5/~
/~ng'I~spector
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 Permit
Storm-Water Assessment Form
Contact:
Mail to: '~,~ ~/d~q ~..-
8EP 25 2009
a. [[,his application MUST [~e co
sets ~ ~'plans, accuttffifidl~l~lan to scale.
areas, and waterways.
PPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date S~1012, ~. ~ ,20~]
I
~pletely filled in by typewriter or in ink and submitted to the Building Inspector with 4
:ee according to schedule.
ot and of buildings on premises, relationship to adjoining premises or public streets or
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 pan for any purpose what so ever until the Building Inspector
issues a Ce~ificate 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.
- (Signatu~e{~ applicant or name, ifa corpo~iion)
,5'o% /lq7!
(Mailing addres~ of~ap~plica~t)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises iq
I ti (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.
Loca!ion ofla..nd o,n v~ich proposed work will be done:
,9,0 U,4 PRiVY-
House Number Street
County Tax Mal~No. 1000 Section
Subdivision }~ gr.? '/>P/-4 ,5J9
1
Block ~t5 -- ~ Lot/3
Filed Map No. ~o ~ I Lot
2. construction:
State existing use and occupancy of premises and intended .use and ocCupancy'of p'roposed
a. Existing use and occupancy ~t/O~[~' ~AB4~[t4
b. Intendeduseandoccupancy ~_lkI(r]~ ~l~lel~lt.I
Nature of work (check which applicable): New Building
Repair Removal Demolition
4. EstimatedCost ~ [Oj ODD:
5.
If dwelling, number of dwelling units
If garage, number of cars
Fee
Number of dwelling units on each floor /
/ Addition~x~Alteration
Other Work
7_ - - o,o (Description)
//~700
(To be paid on filing this application)
If business,
commercial
or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front ~t~ / Rear
Height /._~- t' Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth Height. Number of Stories
8. Dimensions of entire new construction'~r~o°n~t
Height 01/ ~.~ab~ Number of Stories
9. Sizeoflot: Front qL) !
Rear
10. DateofPurchase A/~F' /'~qq
~ _Rear 3 7 ( Depth /,J ~e2. tr
Rear qO z Depth /~ /
Name of Fo~er Owner. ~ l ~ . .J--*.~
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 ~ill excess fill be removed from premises? YES __
14. Names of Owner of premises ~4~tq'l ~tJE-; /I/~-/1 Address~hone No.
Name of Architect ~t~6"w .<,k/--ttJ~q' _ Address I4!3'O'/9~/~"L~ ~; 'ffod'l Phone No
Name ofContracto~ ~ /t~/-5/bi. ~ PLJ~ 1 ~.7 Address q3~F,q~'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.
'%X-'
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
· IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
-~~--~J ~,..~- ] bJg~-~ being duly sworn, deposes and says that (s)he is the applicant
(Nam~ of individual si~c0
(S)He is the 0 [~
(Contractor, Agent, Co¢orate 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. MARINA KOKKINOS
Swom t,.otbtefore me
'----"'-"4 "-Xota
20 U)~ .
Notary Public - State of New York
No. 01KO6191941
Qualified In Suffolk County
My Comnjn~lon Exl~al~ August 25, 2012
/ ~/Signature of Applicant o5Y
:Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERI~t' LOCATION: S.C.T.M. ~
Item Numben
.THE FOLLOWING ACTION8 MAY REQUIRE THE SUBMISSION OF R
STORI~/ATER~ GRADING~ I~RAINA,GE AND EROSION CONTROL PLAN
G~'~l .-lelo BY A DESIGN FR, OeI=aSIONAL IN THE STATE OF NEW YORK.
.coo ?so
(NOTE: A Check Mark (~) for each Question Is Required ~- a Complete Application}
1 Will thla Project Retain All Storm-Water Run-Off Gecemtod by e Two [2") Inch Rainfall on Site? %x./ r'~
(This item will include all mn-off created by site cleadng and/or censtaJction activities as welt as all Site
Improvements and the permanent ~reatJofl of Impef~x~ surfaces.}
2 ocea the Bite Plan and/or Survey Show All Proposed Drainage Structures Indica{ing Size & Location?
This Item shall include all Proposed Grade Changes and Slones Controlling Surface Watad=lowi
3 Wi,, this P ole Requha rad,ngor xcav..on. rethera,se . eto.eNa ra, r'-I
Existing Grade Involving more than 200 Cubic Yards of Matedal within any Parcel?
4 Will this Application Require Land Disturbing Acflviaes Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Sudace?
5 is there =.etu=~ wete~ cocme Ru.nlng th,~gh the S~e? r'"-I ,..,/
Is this Project within the Trustees iurisdiction or within One Hundred (1 Off} feet o[ a Wetland or Beach?
6 oneWill there be Site preparation on Existing Grade Slopes which Exceed Filtoel~ (15} feet of Vertical Rise tOHundred tt 00') of Horizontal Distance? r~ ~/_
7 ~(ill Driveways, Park~lg Areas or other Impelvious Surtaces be Siopeo to Direct St~r~.Water Run.Off r~l
8 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 [he Installation of Driveway Aprons.)
9 Will this Project Requ{re Site Preparation within the One Hundred (100) Year Floodplain el~ any Watercourse?
Yes No
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 Permltl
EXEMPTION: ......
Yes No
Does this project meet the minimum standards for classification as an Agdc,Jltuml Project?
Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan Is NOT Requimdl __ ~
STATE OF NEW YORK, ~'X~, ~ ~_k/. '
.COU T OF ........ '
'""~;"in'i~;'u'~\A ~ '~'I~ ........ being d~y ~m, de~s~ ~d says Out h~slle is file ~p~st for
~t
1,
~d ~at hdshe is ~e
Omer ~Wor ~p~enmfive of~e O~er of O~er's, '~d is duly au&oiled to perform or have peffo~ed ~e s~d wo~ ~d to
m~e ~d file ~s ~plicafion; ~t ti s~temenm ~n~ed in ~is apportion a~ ~e to ~e b~g~ ~efi ~d
~t ~e wo~ ~ll ~ performed in ~e ~ner set fo~ in ~e application filed hereM~.
Sworn to ~fore me ~is; No~ ~u~lle - $~ ~ ~*~
Nmary Public: ...... ~ ...........................................
No. 01K06191941
Quallfled In Suffolk County
My Comm_l~lon Expires August 25, 2012
FORM - 06/07
/~,*~_ ~ ..~.;/,.~ TOWN OF SOUTHOLD PERTY RECORD CARD
OWNER
VILLAGE
DISTRICT SUB. LOT ,~2/_ ,~ 3
N
S
LAND
IMP.
TOTAL
W ~PE OF BUILDING ,/~~
FARM CO~. IND. ,CB. MISC· T ~t. Mkt. Value
DATE REMARKS,
BUILDING CONDITION
NOP, A4AL BELOW
Farm Acre Value Per Acre
Tillable i
Tillable 2
Tillable 3
Woodland
Swampland
Brushlar~l~~
House Plot
t
ABOVE
Value
FRONTAG~ ON WATER
FRONTAGE ON ROAD
BULKHEAD
DOCK
Total
nsi°n ~ ....... ,,.-,..--- ./..-;"- i__ , _ FirePlace -- Heat ,~
' ~D~//~ i Porch Rooms 1st Floor
zeway ~ 'Patio Rooms 2nd Floor
M. Bldg. J~' ~ X ~'7,.' ~ oundat~on
Bath'
s. 69'48' 40' E.
' 47't '
/"lAP '3F PlT. OPlgl~TY
S U F?.,vE¥ ED I:'Qi'Z
. 11,.t IAEL D. FII-2ST
AT¸
B^YVI EW
165.0
165,0
MAP
..)
1
ff~L~
NOTIFY BUILDN~ 5Er'?~TMENT AT
7~D180~ 8AM TO 4PM FOR THE
REQUIREMENTS oF TN~ C':OES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
USE I$ UNLAWFUL
WITHOUT CERT
OP n~,~
ALL CONo FI,,
MEET THE REQUlii,~£1vI,_-i, [ ~, Or- i HE
OODE8 OF NEW YORF'