HomeMy WebLinkAbout35683-ZFORM NO. 4
TOWi~ OF SOUTHOLD
BUILDING DEPA=RTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34468
I~ate: 07/15/10
THIS CERTIFIES that the building ADDITIONS
Location of Property: 2985 HIGHLAND RD CUTCHOGUE
(HOUSE NO.) (STREET) (HANLET)
Co%ulty T~ Map No. 473889 Section 102 Block 8 Lot 14
Su]~]ivision FiledMap No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in tb/s office dated JUNE 21, 2010 pursuant to which
Building Permit No. 35683-Z dated JULY 1, 2010
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" CO~-ERED ENTRY AND MUDROOM ADDITION TO AN EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
· ~ne certificate is issued to THOMAS & KATHLEEN HALL
( OWNER )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
EL~t-rKICAL ~KTIFICATH NO.
PLUMBERS c~TIFICATION DA'i'~D
N/A
N/A
N/A
thorize
Rev. 1/81
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. 35683 Z Date JULY 1, 2010
Permission is hereby granted to:
for :
THOMAS HALL
1210 BRIDLE LANE
CUTCHOGUE,NY 11935
"AS BUILT" PORCH & MUD ROOM ADDITIONS TO A SINGLE FAMILY DWELLING
at premises located at 2985
County Tax Map No. 473889 Section 102
pursuant to application dated JUNE
Building Inspector to expire on JANUARY
HIGHLAND RD CUTCHOGUE
Block 0008 Lot No. 014
21, 2010 and approved by the
1, 2012.
Fee $ 400.00
Auth6'rized Signature
ORIGINAL
Rev. 5/8/02
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION 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 fi'om 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:
I Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to respect 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
Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, A]terations 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:
Date.
Old or Pre-existing Building:
House No. Street
Owner or Owners of Property:
Icheck one)
~ Hamlet
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No. ~'~(~ ~
Health Dept. Approval:
Date of Permit.
Block
Filed Map.
Applicant:
Underwriters Approval:
Lot:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~ ~'~- ~ 0
Final Certificate:
(check one)
Applicant Signature
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] ROUGH PLBG.
[ ] INSULATION
FINAL
[ ] FIRE SAFETY INSPEOTION
] FIRE RESISTANT PENETRATION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING / STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ]m, mm~'t,~m'~mJ~m'~m [
REMARKS:
DATE
TOWN Or SOUTUOLD
BUILDING DEPARTMEN~//~-
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFor[~et
Examined 7 ~' / ,20 /O
Approved 7fI ,20 /O
Expiration I -- / ,20 loQ'--
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
x/Storm-Water Assessment Form
Contact:
Mail to:
Phone:
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20/
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
sliall 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 I8 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 fbr 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. ~ ~--"7
~~(Signature o~on)
(Mmhng address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownbrofpremises "~'ff/~'w'~,'P~ /g/Z/~~L
(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.
Location of land on which proposed work will be done:
House Number Street H~'mlet
CountyTax Map No. 1000 Section ~ Block
Subdivision Filed Map No.
Lot // ~
Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .,~)~,/,~' vz"r')M~,?~
b. Intended useandoccupancy 3"71..-~./r~' /,,'p*'*7-~t7
Nature of work (check which applicable): New Building ....
Repair Removal Demolition
5. If dwelling, number of dwelling units /
If garage, number of cars ,9---
Addition' l.~ Alteration
Other Work
(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
Height ~ S~ ~ Number of Stories
Rear ~" ¢7 / Depth
Dimensions of same structure with alterations or additions: Front
Depth c~ fi' / Height ~ C- t
8. Dimensions of entire new construction: Front ff~r'_.f---
Height ff'--(~/' Number of Stories
9. Size of lot: Front /~/~ r Rear ,~ 5/d2
10. DateofPurchase ///~/ /~t~ ~'~Name of Former Owner
riff' / Rear
Number of Stories
Rear .Depth
.Depth 4/Y ~ /
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO b//
13. Will lot be re-graded? YES__ NO /Will excess fill be removed from premises? YES__ NO v'/
14. Names of Owner of premises
Name o f Architect
Name of Contractor
AddressZ¢~F-,'~:~V,;/'/~t~hone No. 7~-~'r
Address Phone No
Address 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 U//
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
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 J
· IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
COUNTY OF
7-~/_7~j/./~4t,5- /gp/,~.-~ d~(' 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 true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application f'l~II~.'.h.
Sworn to before me this
~.~_ day of ~,o,.~._ 20~mmi[~'onF. xp,resSept. 2b,~---~'~.~
-
o__f Southoid
Erosion, Sed,mentat,on & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
5TORM-WATEI~ GRA~iHG, DRAINAGE AND EROSION CONTROL pL~_H
CERTIFIED BY A b~'~i~rl PROFE~81ONAL IN THE STATE OF NEW'yO~
Item Number: (NOTE: A Chec~ Mark (~) for each Question is Required for a Complete Applica~on)
Yes No
Will this Project Retain All Storm-water Run-Off Generated by a Twa (2")Inch Rainfall on Site? ,J r~
(This item will include all run-off created by site cleadng and/o* construction activities as well as all Site
Improvements and the permanent creation of impervious surfaces.)
Does the Site Plan andlor Survey Show Alt Propased Drainage Structures Indlcaitng Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface Wate~Flowl --
Will this Project Require any Land Filling, Grading or Exsevaiton where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards of Matedal within any Parcel?L.~
Will this Application Require Land Disturbing Activities Encompassing an Ama in Excess of
Five Thousand (5,000) Square Feet of Ground Surface? L.~ --
is there a Natural Water Coume 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 Vertical Rise to
One Hundred (100') of Horizontal Distance? I~l --
intoWill Driveways, Parking Areas or other Impervlous Surfacas be Sloped to Direct Storn~Water Run.Offand/or in the direction of a Town dght-of-way? r~ _
any Item Within the Town Right-of-Way or Road Shoulder Ama?
(This item will NOT laclude the Installation of Driveway Aprons.)
Will this Project Require Site Preparation within the One Hundred (100) Year Fleedp a n of any Watercoume? r~_
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 Issuanse of Any Building Permitl
EXEMPTION: Yes No
Does this project meet the minimum standards for classiticatiee as an Agdcutiural ProlecF/'
Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan Is NOT Required!
STATE OF NEW YORK,
co , r¥ ............ ss
(Name of Individual signing Doctnnent)
And that he/she is the ............... ...~....../~....,~....~..~
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 statements contained in this application are true to the best of h~and belief; and
that the work will be performed in the manner set forth in the application filed herewith.I~ar/.~i.ct..S.~..te,~f ~.ew
~o. mW~b~u~4
Sworn to before mc this; Qualified in Suffolk Count'/
Commission f,&0ires Sept. 25,
........... ..................... ...........................
Notary Public: ~....~?.. ~ ........................................................................................ ~~
BUILDING PERMIT EXAMINER CHECKLIST
Applicant:
Architect/Engineer:
SCT # 1000- / o
Property Address:
*Date Submitted:
Owner:
Subdivision:
Buildin, ,.g Permits (,pO eh/Ex
BP/ta~- g-g/C/OZ-1637~,Info:~BP -g/C/0 z-
Single & Separate Search Required? Y N(~)etermination:
REQ. Lot Size: ACT. Lot Size:
REQ. Front ACT. Front REQ Side
REQ. Height ACT. Height_
Project DescripJ[ion: ~' ~ ~ /
Waterfront? Y o~)
If yes, water body: Panel//
Date Reviewed:
Estimated Cost..-~
Zone: Conforming?
City: ~~ PreCOs?
BP 1375- -z / o0 z-/37 7, Info:
BP__ -Z / C/0 Z- , Info:.
ACT. Side
REQ. LOt Cov. __
REQ. Rear__
ACT; LOt Cov.
PROP. Rear
Flood Zone:
Bulkhead/Bluff Distance:
ADDITIONAL APPROVALS REQUIRED
Suffolk County Health: Y or(~- If yes, '~Bed#: *Date: / / _~ermit#:
- If no, certification requiredi Y 0 Nf~Received: Y or N By:
NYS DEC: eRE-V~C~a/7S Y or~- Date: / / Permit #:
Southold Trustees: Y or(~- Date:
Soutboid ZBA: Y o~- Date: /
Southold Planning: Y or~ Date:
Town Landmark C of A: Y oODTE:
Notes:
Permit #:
Permit #:
Permit #:
/
Town Septic: Y or N
or NJ Letter - Notes:
or NJ Letter - Notes:
- Notes:
- Notes:
*NYS CODE Compliance (page 2)Oor N
Fee Structure:
Calculation:
Foundation: SF l. (
First Floor: SF
Second Floor: SF
Other: SF 2. (
Total: SF
SF)- (
SF)- (
SF)= SF X $__=$
+InitialFee:$ i,q~oo, aa
+ Addition{il Fee ( ): $.
SF)= SF X $ =$
+ Initial Fee: $
+ Additional Fee ( ): $. ~-o o, oO
TOTAL:$ r~at:', oo
NEW YORK STATE CODE COMPLIANCE CHECIGLIST
CLIMATIC/GEOGP,~PHIC DESIGN CRITERIA:
· Ground Snow Load: ~0 , Wind Speed; 120MPH
Weathering: Severe __..Frost Depth: 36" __ Termite: M~H Decay: S-M
Design Temp: 11 tee Shield Underlay: YES . Flood Hazai'ds:
USB/OCCUPANCY CLAS SIFICATION: ?
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION: w~ ff~_<_
DESIGN CRITERIA:~ ENGINEERB~
FULL FRAMING DESIGN ELEMENT~N
HEADERS: ~/N _ WALL STUDs:
CEmlNG JoisTs: ~k~ rLpOR JOISTS~/N
LUI~BER SPECIES AND GRADE~/N
Seismic Design Category/B ,
GLP. DERS: YfN
ROOF ILtFTERS: Y/lq
WDJDOW AND DOOR SCHEDULE:
· NIISSLE TEST REQUIREMENTS: Y/N
EGRESS 5.7 S.F.: Y/N
LIGHT 8%: Y/N
1rENT 4%: Y£N
NAILING/CONSTRUCTION SCHEDULE: ~
MEANS OF EGRESS:~iq
PLUMBING RiSER DIAGRAM:
LOCATION OF FIILE PROTECTION EQUIPMENT: Y~
TRUSS DESIGN:
CERTIFICATION:
ENERGY CALCS:
TOTAL COMPLIENCE Y~
(RETURN TO PAGE ONE)
TOWN OF SOUTHOLD PROPERTY~RECORD CARD
VILLAGE
E ACR.
.9~O
W
LOT / ?.
TYPE OF BUILDING
f COAAM,. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE
REMARKS
Tillable
FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
Meac[owland DEPTH ~. ~j,
House Plot BULKHEAD
Totol
COLOR
Extension
Extension
/~e~
Porch
Breezeway
e~lo7
Total
80"
Foundation
Ext. Walls
Fire Place
Type Roof
Recreation Room
Dormer
-JF G ~. ~. j Floors
Interior Finish
Heat
Rooms 1st Ficor
Rooms 2nd Floor
Driveway
r
inette
DR.
BR.
FIR. B
SURVEY OF LOT I-/
HAP OF HI~HLANP EL~TATES
FILED APRIL 26, IqT7 FILE NO. 65~'7
51TUATE, CAJ'r~
TOi~I, 5OUTHO[ D
SUFFOLK GOUNT(, NY'
SURVEYED I1-~g-2004
5LIFFOLK CODNTY TAX #
IOOO-IO2-~)-14
N
AREA = 40/~O'7 5.F. or O.q2 ACRE
6RAPHIC SCALE Il'= [~O'
0
0
JOHN C. EHLERS LAND SURVEYO1;
6 EAST MAIN ~ N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF.-\~Ip se~'vefi~PROSV)4--330.pro
COLLAR TIE~ ~ [~," O.C IN UPPER THIF~ OE ATTIC
2. IF ~TRAPP1N~ 15 INSTALLED OVER 5HEATHIN~ U~E IOd NAILS A~ / NAILIN~ ~CHEgULE
ALL 5TRAPPI~ HAY 80 OVER OHEATHIN(~ HHEN IOd NAILS USED
TURN-UP
(I) NAIL @
FAC/~IA
APPROVED AS NOTED
NOTIFY BUILDING ~T
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS.
1 FOUNDATION. ~ REQUIRED
FOR POURED CONCRETE
2 ROUGH- FRAMING, PLUMBING,
STRAPPING, ELECTRICAL & CAULKING
3, INSULATION
4 FINAL - CONSTRUCTION & ELECTRICAL
MUST BE COMPLETE FOR C O
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERROR~ISTiN~'
(TO MATCH EXI~TJ
ALL CONSTRUCTION SHALL
MEET THE REQUIFIEMENTS OF THE
CODES OF NEW YOB ( SLATE.
o PAt .TIAL Ft .ONTN ELEVATION
5GALE: I/4"= I'-O" (AT FRONT ENTRY)
'R-Iq)
INCJJLATION
NEN
MUD~,OOH
Ok,tALL HOLD- OHN 5T APPIN
I. (I) ~TE~-AP ON EACH HALL STUD, ~ HI~.AP UNDER 5ILL PLATE
(UPLIPT ONLT')
AND UP ON INSIDE FACE OF 5ILL
INSTALL MIN. I/2" ANCHOR E~DLT5 - ~PACIN~ A~ PER TABLE D.2A, THIS SHEET ~112"
®ENERAL NOTES.
I. ALL ROOF EAVES, RIDGES, RAFTER SPACES ABOVE iNSULATION, UNHEATED ATTIC
SPACES AND FOUNDATIONS CI~&HL SPACES SHALL BE 'vENTILATED AS IHOIGATED
ON THESE PLANS AND IN CONFORI'4ANCE HITH C-OVERNIN¢ RECCdLATfONS.
2. ALL SHEATHIN~ AND 5UBFLC:~DRIN~ SHALL BE EXTERIOR ®I;~ADE AND AS
REQUIRED BY ALL C~OVERNIN¢ REGULATIONS.
D. ALL ROOF RAFTERS SHALL HAVE HURRICANE TIES THAT ATTACH TO TOP PLATE ~ STUD.
4- BLOC. KIN~ SHALL BE PROVIDED TO SUPPORT ROOF GUTTE~.S, EAS(~IA END~,
PROVIDE PO~TS BELOH ALL ¢It;~DER5 ~ BLOCK SOLID DOHN TO FOUNDATION
HALL OR ~IROER BELOH
b. ALL PLUMBINg, ~AO, AND ELECTRICAL ~RK 5HALL DE PERFORMED DY LICENSED
AND IN%~D CONT~CTO~5 AN~ IN AGCO~OANCE HITH ALL APPLICABLE CODE5 AND
~E~ULATIN~ A~NOIES.
N. OONT~6TO~ SHALL iNSTALL M~TAL ~LL TIES AS
IN ACCORDANCE HITH THE NEH 'CORK. STATE RESIDENTIAL BUILIDIN® CODE.
DETAIL SHEET ATTACHEO HITH THESE PLANS EOR HALL TIE LOCATIONS.
,9,. LUIviBER TO BE HEI'4 FIR ~2, Flo=~,50, E= I.~ × I0 ~'
PROJECT=
AS-BUILT ENTRY AND MUDROOIvI
fOt~. THE
HALL P..ESI PENC.,E
2qBD HI®HLANID I~ID, CUTCHO®UE, NY IIq:~5
SEE
EXIST.
RESIDENOE
APPROVED AS NOTED
DATE'~)~')~ B.P · '~°~-~/')~
FEE b~-~o ,bcd BY d'~'~- *~'~
NOTIFY BUILDING DEP/~RTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1 FOUNDATION- TWO REQUIRED
FOR POURED CONCRETE
2 ROUGH-FRAMING, PLUMBING,
STRAPPING, ELECTRICAL & CAULKING
3 INSULATION
4 FINAL-CONSTRUCTION&ELECTRICAL
MUST BE COMPLETE FOR C O.
'S OF THE CODES OF NEW
NOT RESPONSIBLE FOR
PAt TIAL FLOOR PLAN
SCALE: I/4"-- I'-O"
(AT FRONT ENTRY)
¢ib~RWRITERS CERTIFICATE
REOUIRED
LE®ENP
J
EXISTINg, CONSTRLI~TION
EXItSTIN~, CONSTRUCTION
(TO BE ~MOVEO)
COMPLY WITH ALL CODES OF
NEW YORK STA-FE & TOWN CODES
AS REQUIRED AhiD CONDiTiONS OF
¢ /, SOUT-~D TOWN.ZL~'/
¢//. tL SOUTNOED'~LANNING BOARD
ON 'A'
5C-ALE, I/4"= ILO''
PAt TIAL FLOOr;2-, PLAN
(AT REAR DOOR)
(I'4E~ I~ 5~. FT.)