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Home My WebLink About35172-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-34143 12/18/09 THIS CERTIFIES that the building ALTERATION Location of Property: 1560 CEDARFIELDS DR (HOUSE NO.) County Tax ~4ap No. 473889 Section 40 Subdivision GREENPORT (STREET) (HANLET) Block 5 Lot 1.37 Filed ~4ap No. Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 18, 2009 pursuant to which Building Permit No. 35172-Z dated NOVE~ER 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 WINDOW ALTERATION TO AN EXISTING ONE FANILY DWELLING AS APPLIED FOR. ~e certificate is issued to ~kN-NA GEORGILIS of the aforesaid building. ( OWNER ) S~FOI~K CO~DEP~NT OF H]~LTHAPPROIL~L ELR~-rMICJkL U~TIFICATH NO. PLI)MBERS C~RTIFICATION DATHD N/A N/A N/A /~thor~zed Signature Rev. 1/81 OCT ~5 '06 02: 13PM SOUTHOLD BUILDIM~ 631 765 9582 Form No. ~ TOWN OF SOlzI~HOLD BUH,DING DEPARTMENT TOWN I~kLL 76~-1802 APPLICATION FOR CERTIFICATE OF OCCUPA This applic, afimi must be filled in by typewritm' or iltk and subrmttcd to the Building D, For uew building or new use: i. Final ~mwoy ol'propcliy with accumte looatlg~.l of all buildillg$, propc~t¥1ines, lopogra~hic fealur''s, 2, Final Al~pro'~ai from tiealth D''pt. of water supply and sewerltge-disposal (S-9 3, Approval of el~ctncsl installafioffti'om Board oirFir¢ Unds~vriters. P.2 Tow~ or sour~oto form). 4, Sworn state~nent fi.om plumber ca'tifyivl! tll~t the solc~ us~l hi sy~ra eoutaim le*e then 2/10 of 1% lead. 5. Con-at~eccial building, uWus!rial building, mt~ltiple rcsiden~m and similar buildings and inatallatio~, a ¢~rtificat'' o f Code Compliance from architect or ~mgb~xn' r~pomibl¢ for the building. 6. Submit Planning Board Approval ofoomplaed sit~ plan req~rmnents. For existing buildings (prior to April 9, 19$7}]~on-couforming uses, or buildings and "pr~e~sting" land uses: ]. Accurate sm~vy of p:'opcrW showMg ali pl'op~ty liaei, stm6s, b~ldi~ ~d unusual ~tm~l or Iopo~aphic fcature~. 2. A pro~ly completed application ~ud ~ma~l to insp~t si~ by ~e applicant. Ifa Certificate of Oeeupmcy t* denied, the Building !nspector sbal[ state thc t'easo~s tha'efor ~ wfi~ng to the applic~t. C, Fees Certificate of Oecup,avy - New dwelling $25.00, Additions to dwelling $25.00, Alt''rations to dwelling $25.00, Swinmdng pool $25.00: Acc~;sory building $25.00, Additio~ to ,,¢.*msory building $2f .00, Businesses $~0.00. 2. ¢:ertifie~te of Occupa,¢y on Pre.existing Building - $100.00 3. Copy of Certificate vf Occupancy - $.25 4. Updut..xtCerti£oamofOccupancy- $50.00 $. Temporar,/Cerlifieah: ofOcenpancy - Residential $15.00, Commercial $15.00 N¢,w ('onstmotian: ............ {)id or Pre-e×iitSng Building: -~ ~'~m4ion of Property: ._._L~ ____~0 A g ~J ~ cO Houae No. S~t Owner or Owner~ or Properly: ....~.~.~_ ........ ¢~1 ~ S Suffolk County Tax Map No ltl00, Scc~,n .... Q.~ Bilk ~..~ Sub&~ision ........................................ Fil~ Map, l'mni~ No. ~ ~ !.~.]L ...... Date of l'crmil... I J. [.~}]~ .._ Appltmm: .... ~altb Dept. Approw~k Und~dt~s Approval: * Haml''! Lot ,.~.(gO Lot: Pbnning Board Approval: R"xtuest lbr: T¢mporary Cmtificate F~ Sulm~ttod: $ Final C~'tificat¢: 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. 35172 Z Date NOVEMBER 23, 2009 Permission is hereby granted to: ANNA GEORGILIS 1560 CEDARFIELDS DR GREENPORT,NY 11944 for : MINOR ALTERATION TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 1560 CEDARFIELDS DR County Tax Map No. 473889 Section 040 Block pursuant to application dated NOVEMBER 18, 2009 Building Inspector to expire on M3tY 23, GREENPORT 0005 Lot No. 001.037 and approved by the 2011. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ~INSULATION [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESlSTAI~I' CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS~ON [ ] FRAMING / STRAPPING [,~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] .~ ~'~'~ ~m~"m~ [ ] .RE RESb'TA~rr PE.E~RA'n0. REMARKS: DATE INSPECTOR FII~LD INipECT!0N IIEPORT I DATE [ ' COMMENTS FOUNDATION (1ST) . ROUGH ~G & PL~G ~S~ATIO~ P~R N. Y. , ~D~ION~ COUNTS TOWN OF SQUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined [t/~3 , 20 q Approved //~, 20~ Disapproved a/c Expiration PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Plamfing Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Mail to: Phone: 73q ~7 0 / ~ ~1 ~ ~ !~'~ ~uilding Inspector D ~ ~ [[ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. a. Th~T~UST b~ ~.ompletely filled in by t~ewriter or in ink and submitted to the Building Inspector with 4 OC ' 26 2009 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 water~vays. 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, Suflblk 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 r?.~E~ lations, and to admit authorized inspectors on premises and in building for necessary inspections..~ _ ('~{"'X '~-~-. L ~?,_.'~f lica~r)r~r~t,on, (~ignature o app ' \,~i~ ' (Mailing addres§ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises '.~ tq ~ O,. (As1 (~n 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. ~.?~!~,''~ }4 Plumbers License No. Electricians License No. Other Trade's License No. Location of land on ',yhich pro. posed work will be done: House Number Street C~ r e_~r~ D~' ~I'amlet County Tax Map No. 1000 Section 4/0 Block ~ Lot l, 3-"] 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 .~O'v~ ~'.. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal 4. Estimated Cost~/~O' , ~ 5. If dwelling, number of dwelling units If garage, number of cars ~ Addition Alteration~ Demolition Other Workt~xe~,~3 ~\ "&'kO~,~M;,,,o (Description) Fee $ ~,~3~ ,. ~' (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 Rear Height. Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Depth Rear "il , 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear .Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated A 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ 13. Will lot be re-graded? YES NO'%~ NoN Will excess fill be removed from premises? YES INO% 14. Names of Owner of premises Address Phone No. Address Phone No Name of Architect ......... NameofContractor'~-,t>~,~--~ Vo.~.~.--- Address~,~')~\~,~*~ P~honeNo. 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__ * 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO% · iF YES, PROVIDE A COPY. STATE OF NEW YORK) CO TY ~//~-~-~ ~ ~O 2~, being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He isthe (C~nffac.t~r.) 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. // Nora, Public ~ N o~u% iPfiu~i ie~ $stu~ ~o1~ CNo%V~ork~' ' S ignatur e ,d'f~pp, J~a nt ,.To wn _of South_eld Erosion, Sed,mentation & Storm-Water Run-off ASSESSMENT FORM .Item Number. L~ .~ i~ ' ~ THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF It_ __ ' STORM-WATER~ GRADING~ DRAiNAiGE AND EROSION CONTROL PLAN eistrtct s~,tlon C~.~rlI-II~O BY A DESIGN PR, OFESSIONAL IN THE STATE OFNEW YOItK'. (NOTE: A Check Mark ( ~} for each Oueetion ls Required for a Complete ApplicoUon) Yes No 1 Will Ihis Projec~ Retain All Storn~Water RumOff Generated by a Two [2") Inch Rain~all on Site? (This Item will include all run-off created by site deedag and/or construction activities as Well as all Site Improvements and the permanent creation of Itni~rdous sudaoas.) 2 Does the Site Plan and/o{ Survey Show All Proposed Drainage Slructures indicating Size & Location? This Item shall include ali Proposed Grade Changes and Slopes Controlling Surfaco Waten=lowi 3 Will this Project Require say Lend Filling, Grading or Excavalioa where Ihere is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Matadal within any Parcel? 4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excoss of Rve Thousand (5,000) Square Feet of Ground Surface? 5 Is there a Natural Water Coume Runn ng through the Site? Is this Project within the Trustees iurisdiction or within One Hundred (1003 feet of a Wet;and or Beach? 6oneWill thereHundredbe Site[100'}preparati°nof HoHzontaI°n ExlstingDistanco?Grade Slopes which Exceed F~een (15) feet of Ve~col Rise to 7 ~(ill Driveways, Parking Areas or other Impervious Surfaces be SJopecJ to Direct Star'n-Water into and/or in the direction of a Town right-of-way? 8 w,i this .ro, ect Require the .tacement o, Mete.,. Remove, o, Vege tion and,o Oon.tru on ot any Item Within the Tow~ Right-of-Way or Road Shoulder Area? (This item will NOT include [he Installation of Driveway Aprons.) 9 Will this Project Require Site Preparation within the One Hundre~ (100) Year Floodplain of any Watamourse~ NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark i~ the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan Is Requi~:l and Must be Submlffed for Review Prior to Issuance of Any Building Permit! EXEMPTION: -- -- Yes Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Questtan, a Storm.Watar, Grading, Drainage & Erosion Control Plan is NOT Requiredl STATE OF NEW YORK, ;'""'~"~"'~-~ ~ L'~u~dulyswora, de~os~andsa sthath she ..... ........................... ~ .......................... P y ~r ~S me applicant tot renniq And that he/she is the ........................................ Owner and/or representative of the Owner of Owner's, 'and is duly authOriZed to perform or have perforated the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; No. 01~6190696 ............ FORM 06/07 Commission Exoires July 28. 2~ 'DA/~FiEL'DS DRIVE HOLDER. THIS CERTIFICATE ~ MOT AI~D, EXTEND . ~LT~ THE C:__OV/~r~GB AFFORI~EO BY THE .~3L.I¢~S BEt.OW, ~IAIG $ --~S ' ' ' , ......... ~ ~L!CI~S C)F INS~I~*~.,'~C ~ I,i $T~O BELOW ~VE B~N ]GS~J~ ~0 ~ INSURED ~O ~OVE F~ THE HOME IMPROVEMENT I f-- 29872-H ~o'uthampton Town I~cense Review l~oarcZ ."~ OeO~T~m,[i Ilomc Improvcmcnt License ACORD ~ (2001/06) IN $02Is (a',ae),~ CERTIFICATE OF LIABILITY INSURANCE ,3-/ 1 iNSURERS AFFORDING COVERAGE THIS CERTIFtCATE IS iSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER'rIF~CATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NAIC # I~Z 11955 Cut. c~ogue i OA~ 100,C001 J CERTIFICATE HOL DER CANCELLATION <~ ACORD COE.~RA'I'ION t91~8 BLDG. DEPT. TOWN OF SOUTHOLD WALL OPENING MEMBER SCHEDULE SILL SILL TO WAIL CONNECTION (N'rSJ (~pical Wa_Il to Floor Connec~on WIND--BORNE DEBRIS PROTECTON FOR WOOD STRUCTURAL PANEL SHUTTER ASSEMBLY SHUTTER ASSEMBLY j, ,, 'Top p~-~TF- JACK STUD rr is A VIOLATION OFTHE LAW ~ ANY PERSON, UfJLES~ ACTING UNDER THE DCRECTION OF A LICENSED ARCHITECT, TO ALTER ANY I'I~M ON THIS DRAWING IN ANY WAY. ANY AUTHORIZED ALTERAT~N MUST IE NOTtD, SEAI.E[~ AND Di~...RIED IN ACCORDANCE cr _ CEE1 THE REQUIRE,L~EH'£5 -: THE CODES OF NEW YORK STST~ :0 ..... ~"_rE FOR