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Home My WebLink About34831-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-34195 Date: 02/16/10 THIS u~KTIFIES that the building ADDITIONS Location of Property: 49725 MAIN RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 5 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 18, 2009 pursuant to which Building Permit No. 34831-Z dated JULY 6, 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 REAR DECK AND FRONT COVERED PORCH ADDITIONS TO AN EXISTING MEDICAL FACILITY AS APPLIED FOR. The certificate is issued to JAY P & LOTKIN SLOTKIN ( OWNER ) of the aforesaid building. SUFFOLK COD1T~Y DEPARTmeNT OF HEALTH APPROVAL R~.RCTRICA~ c~KTIFICATE NO. PLiErS U~a~TIFICATION DA-r~u N/A N?A Rev. 1/81 FEB z BLDG. DEPT. TOWN OF SOUTHOLD F~orm No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 PPLICATION 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: 1. 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 thc 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, Commereial $15.00 Date. Street Or/ Block Old or Pre-existing Building: House N6. - New Construction: Location of Property: Owner or Owners of Property: ~'-~,8- Suffolk County Tax Map No 1000, Section Subdivision Permit No. 3~/ ~ 5 / Health Dept. Approval: (check one) Hamlet Lot OI5 ~ Filed Map. Date of Permit.~ ~a ~97 Applicant: Underwriters Approval: Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ d fi- Final Certificate: (check one) bAl~pli~t Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII/)ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34831 Z Date JULY 6, 2009 Permission is hereby granted to: JAY P SLOTKIN PO BOX 1437 SOUTHOLD,NY 11971 for : REAR DECK A/DDITION AND ROOF OVER FRONT ENTRY PER ~PPROVED PLAI~S AS APPLIED FOR. FLOOD PERMIT at premises located at County Tax Map No. 473889 Section 070 pursuant to application dated JUNE Building Inspector to expire on J~lqI3ARY 49725 MAIN RD SOUTHOLD Block 0005 Lot No. 004 18, 2009 and approved by the 6, 2011. Fee $ 300.00 Authorized Signature ORIGINAL Rev. 5/8/02 FAIRWEATHER-BROWN DESIGN ASSOCIATES, INC. 205 Bay Avenue Greenport, N.Y. 11944 631-477-9752 (fax) 631-477-0973 February 5, 2010 Southold Town Building Department P. O. Box 1179 Southold, NY 11971 Office building of Dr. J Slotkin, M.D. 50 Ackerly Pond Lane, Southold, NY Building Permit # 30022Z To whom it may concern: This letter is to confirm that based on my observations on several occasions throughout the construction process at the above referenced project, and to the best of my knowledge, belief and professional judgment, the footings for the new deck and porch construction, and the framing strapping and metal connectors for the new deck have been installed in accordance with the Residential Code of New York State 2007, and the WFCM 1995. If you have any questions, or require additional information, please feel free to contact me. Thank you for your attention to this matter. Sincerely, Robert I. Brown, AIA FOUNDATION (1S~ PL~G ~$~A~ON PER N, Y. STATE E~R~ CODE /~/~ ~D~ION~ CO~ENTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net ,/ Examined l~ ,20 PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying7 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: Approved ,20__ Mail to: Disapproved aJc Phone: Expiration 20__ ~. I~ ~ ~ ~ ~ [~ Building Inspector APPLICATION FOR BUILDING PERMIT i B£OG DEPI. INSTRUCTIONS Date~ /~' ,20 0~_ IOWN OF SOUTHOLD 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 authorized inspectors on premises and in building for necessary inspections. State whether applicant is owner, lessee{agent,/karchitect, engineer, Name of owner of premises''/ _~Z),,~ "--Jm~ ~/o//C/t? (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (S~¢/ature of applicant or name, ifa corporation) r ~ailing address of~tlicant){J general contractor, electrician, plumber or builder (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: / t~,~-Number ' Street ' County Tax Map No. 1000 Section dg/~o Block Subdivision / Hamlet 0-5-- Lot Od 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 b. Intended use and occupancy. ~)~ 3. Nature of work (check wh/ch applicable): New Building Demolition 4. 5. Repair Removal Estimated Cost If dwelling, number of dwelling units If garage, number of cars Addition v/ Alteration Other Work Fee (Description) (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 ~,ff- Rear .~5-- _Depth Height Number of Stories 9. 10. Date of Purchase Dimensions of some structure with alterations or additions: Front ' ~ Depth /~0~ Height Number of St0, ~[e=s,, Dimensions of entire new construction' Front £,c//~l ~&/o-o/~ Rear / · ' ' T Cmpth Height Number of Stodes t9 7 Size of lot: Front */3 O Rear --~ca°r'° f'?/~ 7 Depth N~e of Foyer O~er 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES 13. Will lot be re-graded? YES __ NO 7Will excess fill be removed from premises? YES 14. Names of Owner of premises x,,~/o~ Address ~ Phone No. Name of Architect '~a-~-t~Sy-a~-r~ Address ~r~gr~,o~o~' Phone No Name of Contractor Address ~ Phone No. NO ,/ NO z/ 7,?_ 776'3, 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, 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 · IF YES, PROVIDE A COPY. J.,~/~,A~' ~ ~-,~,~d r' ~ ,.;, STATE OF NEW YORK) OU TY ~ ~"~' f'~ ~ 7~)/r// being duly swom, deposes and says that (s)he is the applicant (Name of iffdividual/s]gning contract) above named, (&e 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. Swogl t~,efore me thi,~,'q t~15''k-- day of "'. 1~q.42 20:q' No~ ~blic, S~te of New No. 01CU6100507 Qualified in Suffolk Ccun~ ~mmissi~ ~ms ~t 20 ~na'ture of Applicant JUDITH T. TERRY TOWN CLERK Soufi~old. New York IIqTI '-~ Telephone (5161 765- I NOI OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 2q, 1993: of the Code of the Town of Southold: "Floodplain Application" [FDP(93)], and "Certificate of Compliance Special Flood Hazard Area [C/C(93)]. RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations Development Permit for Development in B~J3G. 0~r~T.. TOWN OF, SO':JT~O~LD, Southold Town Clerk August 25, 1993 APPLICATION PAGE I of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sigh'l: 1. No work may start until a permit is issued. 2. Thc permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is Lssued. 5. Thc permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby inlrormed that other permits may be required to fulfill local, state and federal regulato~ requirements. 7. Applicant hereby give~ consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO A.ND ACCURATE. . THIS APPLICATION ARE, TO THE BEST OF M~Y~QqOWLEDGE. TRUE SECTION 2: PROPOSED DEVELOPMENT (T0 be completed ~v APPLICANT} APPLICANT BUILDER, ENGINEER NAME ADDRESS TWl .I~PHONF F To avoid delay in processing thc application, please provide enough information to easily identify thc project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to ~ application showing thc project location would be helpful. I FDP(93) APPLICATION # PAGE 2 OF ,~ DESCRIPTION OF WORK (Check ali appticable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ~AeW Structure ddition [] Alteration [] Relocation [] Demolition [] Replacement [] Residential (1-a Family) [] Residential (More than 4 Family) [] Non-residential (Floodproof'mg? [] Yes) [] Comb;ned Use ('Residential & CommerciaJ) [] Manufactured (Mobile) Home (In Manu- factured Home Park? [] Yes) ESTIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: El Fill [] Mining [] Drilling ~Grading [] Excavation (Except for Structural Development Checked Above) · [] Watercourse Alteration (Including Dredging and Channel Modifications) [] Drainage Improvements (Including Culvert Work) [] Road, Street or Bridge Construction [] Subdivision (New or Expansion) [] Individual Water or Sewer System [] Other (Please Specify) After completing SECTION 2, A2PPLICANT should submit form to Local Administrator for revie~w. SECTION 3: FLOODPLAIN DETERMINATION (To be completed bv LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: FI Is NOT located in a Special Hood Hazard Area (Notily the applicant that thc application review ia complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). Fl Is located in a Spedal Flood HaTard Area. FIRM zone designation is I00-Year flood elevation at thc site ia: Ft. NGVD (MSL) [] Unavailable El The proposed development is located in a floodway. F'BF'M Panel No. Dated [] Sec Section 4 for additional iustruc6ons. SIGNED DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the apphcation can be processed: [] A site pla~ showing the location of all existing structures, water bodies, adjocent roads, lot dimensions and proposed development. [] Development plans, drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the first floor, details of floodproof'mg of utilities located below the first floor and details of eudosurns below thc first floor. AL~o, [] Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide lfl0-year flood elevations if they are not otherwise available). [] Plans showing the extent of watercourse relocation and/or land/om alterations. [] Top of new Eft] elevation Ft. NGVD (MSL). El Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from reg/stered engineer or architect. [] Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of ail data and calmflations supporting this Finding must also be submitted. El Other: SECTION 5: PERMIT DETERMINATION (To be' completed by LOCAL ADMINISTRATOR'~ I have determined that the proposed activity:. ,6.. [] la B. vi Is not in conformance with provisions of Local Law ~8 , 19 attached to and made part of th;, permit. __. The permit is issued subject to the conditions SIGN'ED , D~.TE If BOX A is checked the Local Administrator may issue a Development Permit upon payment of designated If BOX Bi$ checked~, the Local Administrator will provide a written summary of deficicnci~. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPEALS: Appealed to Board of Appeals? O Yes [3 No Hearing date: Appeals Board Decision --- Approved? [] Yes Conditions E] No APPLICATION # PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS (To be submitted bv APPLICANT before Certificate of Compliance is issued/ The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certiflcatlon to this application). Complete 1 or 2 below. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, ~cludiag piling and columns) ia: Fr. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproof'mg protection is PT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To ~e completed l~v LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with- the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIES? 13 YES [] NO DATE BY DEFICIENCIES? I'1 YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed bv LOCAL ADMIN1STRATOR~ Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIkNCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZAJUD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [] EXISTING BUILDING [] VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: Ao COMPLIANCE 1S HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW # ,19 SIGNED: DATED: OF COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19__, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) TOWN OF SOUTHOLD PRC~PERTY RECORD CARD OWNER STRE~ jr/ /"Z-5 WLL~GE D~ST.SUB. LOT FOR~ER OWNER E R"S~,f S~S. VL. FARM CO~. CB. MICS. Mkt. ~ND IMP. TOTAL DATE R~RKS N~ FARM Acre Value Per Volue Ac r~ Tillable FRONTAGE ON WATER W~la~ FRONTAGE ON ROAD ~adowland DEPTH BULKH~D Hou~ Plot ~ ~ D~K M. Bldg. ExtensioT~ Extension Extension Porch Breezeway C~rage O. B; f //×.2. /ox/ II X I~~ Foundation Basement. Ext. Walls Fire Place ~' t' Recreatioh Room Dormer Interior Fihish Heat Rooms 1st'Floor Rooms 2rid Floor Driveway LR. DR. Extensi°~',5/-'/'~ / '/K / ,i' FA ~ g. v.~ Exten~inn - _G I 2 3 4 5 ~ 7 8 ~ I0 II 12 13 14 15 I~ 17 RESIDENTIAL GENERAL NOTE5 ~*uE~¢~,~,o.~ OGGUPANr ~ ( "" ~OUNDATION ~LOW G~DE P~N~, ~ REQUIREMENTS OF THE CODES OF NEW ~WN O~ ~ ~ ~ ~ .~.~ ~ / / "'~ DO NOT 5CAL~ D~WIN65, PO~OW DIMENSIONS ONLY, ~ = ~pd GALVANIZED M~TAL CON N E~TO~ BY "51MPDON" O~ APPrOVeD ~QUAL, /~ ', ~' 5~HOLD, TOWN OF 50UTH LD ~ X ~ ~D~TOALIGN W/ V~'~ AND SIT, CONDITIONS ~ ~%~JCOLUMN ..... ~ ~,x _~,,~K CLIMATIGANDG~OG~PHICC~T.,IA CAIRW~TH~R-BROWN AND BEAM T COLUMN 3-3/, ax ALU MINU M MAND~IL ~l J -~" DIA, I WIND 5P~O I ~0 HATCHED AREA 2,479,3 5q.~. = DESIGN A550CIATE5, INC.I~ ~%~" .J2/ WIN~EDESlGNTEMP IMF (PEKTABLE NJ IOi.2) 9.2 5 2% PRO~. COVE~G~ ro~ JAY 5LOT~IN 5T,r~. A. ,~C~A~V ~ r~O~T L~,~ ~, 3~" T E P L AN~ NO. 1000-070-05 04 , ~ 7 ,, T.OLB~R ~ ' B~SiGN LOAD CALCU~TIOND,UNIFORM LIV~ LOADS) t ~lSTING TO ~EMAIN ~ NEW SECOND PLO0~ OVER 8ANDJOISTTOJOISTfEN~NAI~D) ~-I~ p~OI~T ~CEPT A5 NOTED (~ISTING GARAGE LEVEL) ~XIDT[NG TO REMAIN NEW SECOND PLOOR OVER ~F ~H~THINGsT~DCU~L pAN~~ 5CA~'PORCHI/4"= I'-o"D~TAIL~L~ PORCH DETAIL~ / / · --~--(~ I ?O~RED CONCRET~ PO~CH * 5TEP~ DECK CEDAE (PAINTED) EXISTING DECK i I O~P ALL A*OUND tN ~*ICK ANy WA~ ANY A.mORm~ K J M G F D C D A