HomeMy WebLinkAbout35912-ZFORM NO. 4
TOWI~ OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34594 Date: 10/06/10
THIS u~TIFIES that the building DECK ADDITION
Location of Property: 1250 WHITE EAGLE DR LAUREL
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 127 Block 9 Lot 18
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 8, 2010 pursuant to which
Building Permit No. 35912-Z dated OCTOBER 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" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to DONALD & ROSEANN GAVIN, JR.
(OWNER)
of the aforesaid building.
SUFFOLK COUNTYDBPART}iENT OF H~ALTHAPPROVAL
R~.R~-i-~ICAL c~TIFICATE NO.
PL~MBE]~ CERTIFICATION DA'r~D
Rev. 1/81
N/A
N/A
N/A
TAh°ized~ignature
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. 35912 Z Date OCTOBER 1, 2010
Permission is hereby granted to:
DONALD GAVIN
1250 WHITE EAGLE DR
LAUREL,NY 11948
for :
"AS BUILT" DECK ADDITION TO AN EXISTING DWELLING AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 127
pursuant to application dated SEPTEMBER
Building Inspector to expire on APRIL
1250 WHITE EAGLE DR LAUREL
Block 0009 Lot No. 018
8, 2010 and approved by the
1, 2012.
Fee $ 400.00
Authorized ~Signature
Rev. 5/8/02
ORIGINAL
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application xnust be filled in by typewriter or ink and submitted to the Building Department w
A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and
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
5. Commemial building, industrial building, multiple residences and similar buildings and insl
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
th{following:
nat. ral
10 c [ 1% lead.~
llati ~
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 the reasons therefor in writing to the applicant.
C. Fees 1. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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.
Owner or Owners of Property:
Suflblk County Tax Map No 1000, Section
Old or Pre-existing Building:
Date. ~:~ :~7'-t ~',.,~ ~---/~
~/~ (check one)
Street
Block O~;:~ Lot
Subdivision Filed Map. Lot:
PermitNo. '~'~:~tt2 DateofPermit. /~/t:gt'/~ Applicant: ~-~,d~e4~'~ ~t'_~'~.//-z~'t{J/gt~
Health Dept. Approval: ,~./~r Underwriters Approval: ,4~'~
Final Certificate:
Planning Board Approval: t4~
Request for: Temporary Certificate
Fee Submitted: $ ~:::~ ~
(check one)
Applicant Signature
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN~I,ILATION
[ ] FRAMING / STRAPPING [~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SA~-.., ~' INSPECTION
[ ] F~RER~mSTJU~r~ [ ] RREREmSTANT~ETRATH)N
DATE
INSPECTOR~~~
TOWN OF SOUTHO~,D
BUILDING DEPARTMENT'
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 76~-1802
FAX: (631) 765=9502
SouthoidTown.NorthFork. net
/
o// ,
Approved ~ , 20/~:~
Disapproved a/¢
Expiration
8 2010
BL06. OE~.
~,0F SOUT~OU)
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, In:fore applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trostecs
Flood Permit
Storm-Water Assessment Form
Contact:
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20/0
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 pa~ 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. Thereaf~r, 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 appliceble 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 necessmy inspections.
(Signature of applicant or name, ifa corporation)
(Mailing add,ss of applicaat)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises ~f/~6~//f_~ Pd~ b////7
~s 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 Tmde's License No.
1. Location of land on which proposed work will be done:
House Number Street
Haml~
Block
Filed Map No.
County Tax Map No. 1000 Section Lot ,/,,~
Subdivision 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 which applicable): New Building
Repair Removal Demolition
4. Estimatexl Cost
5. If dwelling, number of dwelling units
If garage, number of cars
Addition
Other Work
Alteration
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commemial or mixed occupancy, speci~ nature and extent of cach type of use.
7. Dimensionsofexistingstmctures, ifany:Fmnt ~/~) ! Rear ~ ~1 Depth ~----/~,,-~
Height
Number of Stodes
Dimensions of same structure with altera~ons or additions: Front
Depth ~.~ Height .~ ~/t Number of Stori~
8.
Dimensions
of entire
new
construction:
Front
Rear
/
Height Number of Stories [ .... }-~ ...... J
9. Sizeoflot:Front / ~-',~g~ 4'r~'/ Rear .~,::9 , ~:~~ Depth ~._~-~,
10. Date of Purchase ,~.ff~ '~Z Name of Former Owner ~'~r'~' ~
11. Zone or use district in which premises are situated /'~
12. Does proposed construction violate any zoning law, ordinance or regulatiun? YES__ NO (/~
13. Will lot be m-graded? YES__ NO ~//Will excess fill be removed from premises? YES__ NO__
14. NamesofOwnerofpremises ~P~'~,~ga~','2~ Address~a//~',z~a~ ~/.,~ PhoneNo.
Name of Architect V Address Phone No
Name of Contractor Address Phone No.
15 a. ts this property within 100 feet ora tidal wetland or a freshwater wetland? *YES NO
* IF YES., SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BEJIEQUIRED.
b. Is th~s property within 300 feet of a tidal wetland? * YES NO 9/
* 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 o~urvey.
18. Are them any covenants and restrictions with respect to this property? * YES NO ~
· IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
cot vv or
2/~9/~ ~/~'~/t/~'~'~eS~t/ being duly sworn, deposes and says that (s)be 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.
Swg. m to before me this~
VICKI TOTH
Notary Public,Stete of New York
No. 01T06190696
Qualified in Suffo k County
Commission [xpires July ~8,
' ~~Apphcant
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERT~ LO~ATION: S.C.T.M.~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
~-~ ~ ILo~ STORM-WATERi GRADING, DRAINAGE AND EROSION CONTROL PLAN
Dtst~ctsectto~ Block CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
CONSTRUCTION ri'EM# / WOILKASSESSMENT [ Yes No
SCOPE OF WORK
PROPOSED
a. What is the Total Ama of the Project Parcels? 1 Witi this Project Retain All Storm-Water Run-Off
(IncludeTotalAreaofatiParcelslosatedwithin .~//~ ;~_..~_~ ~F Generated by a Two (2") lnch Rainfatl on Site? .ZF
the scope of Wed( for Proposed Construction) (S.F I Aaes) (This item will include all mn-off created by site
b. What is the Total Area of Land Cleating cleadng and/or construction activities as well es all
and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of
construction activity? 4:::~4Z~--' ~F impervious surfaces.)
(S.F~ / A~ss) 2 Does the Site Plan and/or Survey Show AIl Proposed
PROV]]:)E BEI[F PRO.~.CT D]ES~ON (Pm~d. A~o..~',,ge... t,~ed~) Drainage Stroctures Indicating Size & Location? This
Item shaft include all Proposed Grade Changes and --
~ --/r~/~. ~--~ , Slopes Controlling Surface Water Flow.
_____ 3Does the Site Plan and/or Survey describe the erosion r~
~..~z,~;z ~ ..~'~' ~f.~z~7~ ~""~"~/-//~ and sediment control practices that will be used to
control site erosion and storm water discharges. This --
· .~'Z~"--~:) ,~/,~"~"- ,~,,x--~c item must be maintained throughout the Entire
Construction Pedod.
'-- /'~U~ ,~'~/-?' -~2'Z~Z~../~-~ 4 Wiil this Project Require any Land Filling, Grading or
~, ~'//Z~'~ ~f.~/~'~ . - Excavation where there is a change to the Natural O
,/~---'//~,*//-*~'~*~'(~ Existing Grade Involvlng more than 200 Cubic Yards __
~...~/~..p of Material within any Parcel?
.7'- '~;Z~."2,~/~7-'" 5 Will this Application Require Land Disturbing Activities ~
Encompassing an Area in Excess of Five Thousand
V
(5,000 S.F.) Square Feet of Ground Surface? --
6 Is there a Natural Water Course Running through the D V//
site? Is this Projeot within the Trustees jurisdiction
General DEC 5WPPP Requirements: or within One Hundred (100') feet of a Wetland or --
Submission of a SWPPP is required for all Construction activities involving soil Beach?
dis~Jrbancos of one (1) or mom acres; including disturbances of less ~an one acm that 7Will there be Site preparation on Existing Grade Slopes ~
are part of a larger common plan that will ultimste[y disturb one or mom acres of land; which Exceed Fifteen (15) feet of Vertical Rise to I
v
tsduding Consttuction activities involving soil disturbances of less than one (1) acm where One Hundred (100') of Horizontal Distance? I~1 --
th~ DEC has determined thai a SPDES permit is required for storm water discharges.
SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious
,/
for Storm Water Discharges from Construction activity - Permit No. GP-0-10-001 .) Surfaces be Sloped to Direct Storm-Water Run-Off V
1. The SWPPP shall be prepared prior to the submittal of the NOI, The NOI shall be into and/or in the direction of a Town right-of-way?L~J --
submitted to the Department pedr to the commencement of constmctton activity.
2. The SWPPP shall descdbe the eroblo~ and sediment control practices and where 9Will this Project Require the Placement of Material.~
required, post-constmctfon storm water management practices that will be used and/or Removal of Vegetation and/or the Consbuddon of any I I
V
constructed to peduce the pollutants in storm v~ter discharges and to assure ~tem Within the Town Right-of-Way or Road ShoulderI~1 --
identify potential sources of pollution whtc~ may reasonably be expected to affect the
STATE OF NEW YORK,
....... ss
q_hat I, ~....~.........~...~.~....~..4...~..../. ................ being duly sworn, deposes and says that he/she is the applicant fo,- Permit,
And that he/she is the ...~.~ ..~.... ..................................................................................................................................
Owner and/or representative of the Owner or Owners, and is duly authorized to peffom~ or have performed the said work and to
make and file this application; that all statements contained in this applicadon 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~fi
Sworn to before me this ,,'ll/'r'w..
................. . .~........~.... .......... ;.v~t.ay of .i~.~.~ ........ 20...g//,-~) ///~//~//JJ///j, ~
Notary Public: .....~.. '~....~...~.~.~.~ ............................... ~"v~l{;~?e~f New'fol~"~ ''/''' ................................
N°ta~y~m~c,,~tQnggG ~"V -
FORM - 06110 Qualified Coun~
Commission E ~ 28.
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER $1'REET / ~'~O VILLAGE DIST. SUB. LOT
FORE. OWNE~ ,, ~ ~ AC~
O,,'aR~,U.~.. F--r't'cLc.~o,~ S W TYPE OF BUILDli~
RES. '7~tb SEAS. VL.~ FARM COMM. CB. MICS. Mkt. Value
W~lund FRO~AGE ON ROAD
~d DEPTH
Hm~ PI~ BULKH~D
._L-------,--~-"- ~ Foundation :X C, Bath
;xtension xa~,~ - ~0~ ~ ~ ~ Ext' Walls :V~,t[ S~,a~ Interior' Finish
D.~. ~
~, ~ ~ /
~~ /~ /
WHITE EAGLE DRIVE
Hght ~f wa~ and or easement,
LAND QUE51 ~LE AGENC~ CO~- ~ROLD F. TRANCHON JR. P.C.
P.O. BOX 6~
AS-BUILT DECK
447 SF
22'
lAS-BUILT BONUS RM.I
EXT'O
FRAME
2-STOR
DWELLIN
EXT'G RESfDENCE
WHITE EAGLE DR VE
LEGEND
~ EXISTING STRUCTURE
F--1 AS-BUILT DECK
~ AS-BUILE BONUS ROOM
SURVEY BY HAROLD F. TRANCHON JR., P.C.
DAED: 5/11/2005
LOT AREA = ca. 41226 SF
APPR
N :-IF ~bl .DING DEPARTMENT AT
765-1~ AM TO 4 PM FOR THE
FOLLC,.. N, INSPECTIONS;
1. FOUN TW 2 REQUIRED
FOR PC ~RED CONCRETE
2. ROUG,~. :qZM!NO ~LUMBING.
STR~P!~ ELECTRICAL & CAULKING
3. INSU! ,:
4. FINA.
MUS'
/NJ. CON
REOb,P
YORK S
DESIGN
'. ': JCTICN & ELECTRICAL
:JPLETE KOP C 0
JCT'PN S~ALL MEETTHE
N~- }~- ~'-~E CODES OF NEW
' '= PES:~ONSIBLE FOR
UCTION ERRORS.
WHITE EAGLE DRIVE
PLOT PLAN
SCALE: 1/16" =1'-0"
SITEPLAN
SCTM~/= 1000-127-09-18
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
AS-BUILTS
DECK &
BONUS RM.
RESIDENCE
1250 WHITE EAGLE LN
iLAUREL, NY 11948
ARCHITECT
FRANK UELENDN-IL
P.O.BOX 316
GREENPORT, NY 11944
TEL: 631-477 862,1
OWNERS
DON & ROSF~N GAVlN
2007 BRIDOEW^~ DR.
LAKE MARY, Et ~2746
EL: 407-,166-2131
DATE: 09/07/2010
SCALE: 1/16' = F-0'
SITE PLAN
DWG. N~E
A-1
DWO. NO
SEPTEMBER 7, 2010
FRANK W. UELLENDAHL, ARCHITECT - P.O.BOX 516 - GREENPORT, NY 11944
22'
7 RISERS @ 6.5"X12"
JSiROOM
GARAGE
34'_4~
RAILING SYSTEM
HEIGHT: 3'-0'
APRON: VERSATEX LATFICE
WEATHERBEST DECKING
ABOVE
-- 4X4 TREATED POST
ON 8" D/A CONC, FOOTING (TYP.)
TRf'D 2XlO AROUND ECK
D.J. @ 16" O.C,
DECK FRAMING PLAN
ACCESS DOOR I I Ii
L~CABLE ICEILiNGORILLE o / ~ ~N.~-- :__
~ II
HIC
~ I
MBR MBATH FI
SECTION
AS-BUILTS
DECK &
BONUS RM.
RESIDENCE
1250 WHITE EAGLE LN
LAUREL, NY 11948
ARCHITECT
FRANK UELLI~IDAHL
P.O,BOX 316
GREENRORT, NY 11944
TEl: 631-477 8624
OWNERS
DON & ROSEN'iN GAV1N
2007 BRll)6E~AT~ DR.
LAKE MAIi'~, Fl. 32746
TEL: 407-466-2131
.OOR PLAN
DATE: 09/07/201{
SCALE: 1/4" = ILO"
BONUS RM PLAN
DECK DETAIL
DW6. NAME
A-2
)W6. NO