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HomeMy WebLinkAbout35911-ZFORM NO. 4 TOW/g OF SOUTHOLD BUILDING DEPA=RTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34694 Date: 11/19/10 THIS ~KTIFIES that the building PORCH ADDITION Location of Property: 1050 ROBINSON LA PECONIC (HOUSE NO.} {STREET) {HAMLET) County Tax Map No. 473889 Section 98 Block 4 Lot 31.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 16, 2010 pursuant to which Building Permit No. 35911-Z dated SEPTEMBER 30, 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 COVERED PORCH ADDITION TO AN EXISTING ONE F~_MILY DWELLING AS APPLIED FOR The certificate is issued to RICHARD J & JOYCE B LACEY (OWNER) of the aforesaid building. SUFFOLK COUN~TY DEP;~ITT4ENT OF HE~J~TH A~PRO~-AL RLRCTRICAL C~KTIFICATE NO. PLDMBE~S C~U(TIFICATION DA'r~4~ N/A N/~ Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES IINTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35911 Z Date SEPTEMBER 30, 2010 Permission is hereby granted to: RICHARD & JOYCE LACEY PO BOX 122 PECONIC,NY 11958 for : 18' X 24' OPEN PORCH ADDITION TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 1050 ROBINSON LA PECONIC County Tax Map No. 473889 Section 098 Block 0004 Lot No. 031.001 pursuant to application dated SEPTEMBER 16, 2010 and approved by the Building Inspector to expire on MARCH 30, 2012. Fee $ 200.00 ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]/~/N~ATION 2ND [ ]I~U~TION [ ,~ FRAMING / STRAPPING [ ~I:INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ]FIRERESISTAHTCO#STRUCTI~ [ ]RRERESISTANTPENETRA110N DATE INSPECTOR~~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-t 802 INSPECTION [ ] FOUNDATION ¶ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] ~ULATION [ ~FINAL [ ] FIREPLACE&CHIMNEY [ ] FIRE SAr,- ~ ~' INSPECTION [ ]ImERESISTAN'i'(:M6'mUCn~ [ ]FLRERESm'ANTI~NE'mATION REMARKS, DATE ~ INSPECTOR ~TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION2ND [ ]INS~ [//j~lN~l~ ~ ~/~ [ ]FRAMING / STRA~NG [ ]FIREPLACE & CHIMNEY [ ] FIRE~AI~q~ INSPECTION [ REMARKS: ] FIRE RESiSTANT CONSTRUCTION [ ] FIRE RESiSTANT PENETRATION DATE ~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined /O~/ 20 /O Approved /O'-- I ,20 lO Expiration PERMIT NO. 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. Tmstees Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS /4 ,20/o 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 lbr 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 necessm*y inspections. ~' / (Sigr~a.a~of applica~name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner ofpremises ~h/..~Z ~-.~f~'~W. , ~.J~' ~--' (As,dh 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. 1. Location of land on w,hich proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section Block D q', g>O Lot t57 ~.~/,, Od/ Subdivision Filed Map No. Lot State existing use and occupancy of premises and intended usA,and occupancy of proposed construction: a. Existing use and occupancy / b. Intended use and occupancy / ,~,a.4t/,~- 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~' ~ ~)., ] 0/_.~. ~::>C-~ Fee 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, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front 7'~/' Rear 7~" Height /'~" Number of Stories Depth ,~O r Dimensions of same structure with alterations or additions: Front 7z/' Rear '~/-~' Depth ..~" Height /,~' ' Number of Stories Dimensions of entire new construction: Front /e~ / Rear Height /~. ~' ~ Number of Stories / Depth 9. Size of lot: Front /fi/..9 ' Rear /O~9'' Depth ,~. e9,~ ' 10. Date of Purchase /~'"/~'-,~¢'¢'/ Name of Former Owner 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 /,""/'Will excess fill be removed from premises? YES__ 14. Names of Owner of premises~Address~Phone No. ~._~ NameofArchitect ~,..o~o~t~,.,.¢~,~ ~'~F_~/ Address/7~''~' ~',.Y-~O~-~ e,~ PhoneNo ,~ Name of Contractor ~a ~,~,~,,~ ,~o./,~., Address f.o'fl,,~.' ~,'~ '-~ Phone No. 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. NO STATE OF NEW YORK) SS: COUNTY OF,.~cl& ) ~1'5~..~.,~oo/ -.,/ ,~,,~:~r~, ~"~" being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) ~ove named, (S)He is the Sworn to before me this {,to day of ,~p'~e% 1loo--4r 20 t~ Notary Pt~olic of said owner or owners, and is duly authorized to pertbrm 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 mann, er set forth in the application filed therewith. ~UfA~yp~/l~.O. rios OWNER !STREET 1~0 VILLAGE DIST. SUB. .FORE~,OWNER N E AC%, J ,r~ 5 W ~PE OF BUILDING ~E S~S. VL. FARM COMM. CB. MISC. Mkt. Value ~N D IMP. TOTAL DATE REMARKS Tillable 1 Tillable 2 Tillable 3 Woodland $~ampland FRONTAGE ON WATER ~rumland FRONTAGE ON ROAD J ~,~ ~ ~ouse Plat DEPTH BULKH~D total D~K M. Bldg. ~ Extension? Extension Extension Porch Porch Breezeway Garage Patio O.B. Total Foundation 'C [~ Bath Basement ~ ,~/~ ~, - Floors Ext. Walls Interior Finish Heat Rooms ist Floor Rooms 2nd Floo Fire Place Type Roof ~[~Recreation Roo~ /Dormer Driveway BUILDING PERMIT EXAMINER CHECKLIST Applicant: SCTM# 1000- Property Address: Subdivision: *Date Submitted: Owner: ~,'~/~-/ o Date Reviewed: liP-I-lo Estimated Cost: ~'~.~ / 0 O--- Zone: t~~l/-O Conforming? /q/~. City: ~ Pre COs? ~' Building Permits (Open/Expired): BP__-Z / C/0 Z~ ~ Info: BP -Z / C/0 Z- , Info: BP__-Z / C/O Z~ __, Info: BP~ete-Z / ,C/O ,Z,-~, Info: BP __-Z / C/O Z- , Info:. Single & Separate Search Required? Y o rmmatlon: REQ. Lot Size: ~0 & ACT. Lot Size: /o.~ o o o REQ. Lot Coy. ~-~ ACT: Lot Cov. ~ P,.EQ. Front 3~- ACT. Front ~o REQ Side /a ACT. Side/_~_ REQ. Rear ~.-W~ PROP. Rear ~ REQ. Height.~f ACT. Height o1~ g~.~,~tt$l~e$ ~-,l ~ ACT g~(o · · · · * ' / b~ / ~ Waterfront? Yo~ ~ ' --- ~ - , ~ .... ~.:~ Ify~,water body: ~0 Panel~ [ ~ Flood Zone: ~ Bul~ead/BluffDlstance: - ADDITIONAL APPROVALS REQUIRED Suffolk County Health: Yo If yes, *Bed#: *Date: / / *Permit#: - If no, certification required: Y or N Received: Y or N By: NYS DEC: rRE-DEC 9n/75 Y o~)Date: __ _ Southold Trustees: Y. or(~- Date: /__ __ Southold ZBA: Y o~)- Date: /__/__ Southold Planning: Y o~- Date: Town LandmarkC of A: Yo N~TE: __ __ / / Permit #: / Pernfit #: Permit #: / Permit #: / / Town Septic: or NJ Letter - Notes: or NJ Letter - Notes: - Notes: - Notes: *NYS CODE Compliance (page 2):/~3~or N Notes: Fee Structure: Calculation: Foundation: ~ SF 1. ( First Floor: ~.~ SF Second Floor: 0 SF Other: SF 2. ( Total: SF SF)- ( SF)- ( .SF)= SF X $ =$ + Initial Fee: $ + Addition.al Fee ( ): $ SF)= SF X $__=$ + Initial Fee: $ + Additional Fee ( ): $ TOTAL:$ ~O, oO NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC DESIGN CRITERIA: ~7{7 · Gro!md Snow Lead: ~.0 ,. Wind Speed; 120MPH Seismic Design Category/B Weathering: Severe __ -Frost Depth: 36" __ Termite: M-H ' Decay: S-M. Design Temp: 11 'Ice Shield Underlay: YES. , Flood Hazards: USE/OCCUPANCY CLASSIFICATION: / ~. ' HEIGtiT/FIRE ARBA:~ r~ . T,nm OF CONSTr<UCTION: FULL FR2AMING DESIGN ELEMENTS{~/N HEADERS: Y/N WALL STUDS: Y/N CEILING JOISTS: Y/N FLOOR JOISTS: Y/N LU1V[BER SPECIES AND GRADE: YfN GLRDERS: Yfl'q ROOF ILaAUPERS: Y/N WI]qDOW AND DOOR SCHEDULE: · MISSLE TEST RE_QUIREMENTS: EGRESS 5.7 S_.F.: LIGHT 8%: ~rENT 4%: NAILING/CONSTRUCTION SCHEDULE:~N MEANS OF EGRESS:~N PLUMBING RiSER DIAGRAM: Y~ o LOCATION OF FiT'xt~ PROTECTION EQUIPMENT: TRUSS DESIGN: Y~ CERTIFICATION: Y0 o~ ENERGY CALCS: Y~) TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) ToWn of Southold ;= Erosion, Sedimentation & S~torm-Water Run-off ASSESSMENT FORM  PROPER~Y LOCATION: $.C.T.M. #: THE FOLLOWING A~IONS MAY REQUIRE THE SUBMI~ION OF A ~ ~ ~, / ~O~'WATE~G~ING, D~INAGEANDEROSIONCO~OLPI~. DIs~ct ~. ~k ~ CERTIFIED BY A DESIGN PROFE~IO~L IN THE ~A~ OF N~ Y~ SCOPEOFWO~ - PROPOS~ CON~U~ON ~ / WO~~ [ Y~ No ~ a.~t~To~Pm~Pa~? (l~eTo~l~ofal]~~ ~ ~ I ~ll~je~Re~ln~W~ ~ ~ of W~ ~ P~ ~) ~nem~ by a T~ (2~ I~ ~11 ~ ~? ~ea~ng a~ ~ a~ ~ ~ ~ i~m mu~ be ~in~ ~g~t ~e ~ C~ Pe~. ~ G~de In~ng ~m ~an ~0 Cubic Ya~s ~/~ O~ of Matedal ~hin any Pa=~ / 5 ~11 this Appli~on Require La~ D~g ~fl~ En~pa~i~ an ~a in ~ss of F~e ~ou~ (5,000 S,F,) ~u~ Feet of Ground Su~? 6 Is ~ere a NaOmi Water ~ume Runni~ ~h ~e Site? Is ~ ~Je~ ~in ~ Tm~s ~ General DEC ~PP R~ulm~n~: or ~ln One Hund~ (1 ~) feet of a W~a~ ~ dbt~of~e(1)~; ~d~n~sofl~~ 7 W~t~S~eprepa~nonExl~G~eS~s ~n~ ~s~ ~ i~g ~il d~r~s ~ ~ ~an ~e (1) a~ ~em One Hundr~ (100') of Ho~tal D~n~3 ( s~ ~ ~t ~e ~nimum Re~men~ ~ ~e SPDES ~n~ P~E 8 Will D~ys, Pa~ ~as or o~r Im~ ~. ~ ~ ~ ~t ~ ~t ~ ~ ~ ~ Rem~l of V~ a~ ~e ~ ~ a~ ~ ~ ~ t~ a~ ~ ~ ~ ~ ~ ~ ~ ~ sha~ I~m ~ln ~ T~ ~Mmf-Way ~ Ro~ S~~ __ ~d ~at h~she i~ ~e ...~.~ ..... ~ . ~cr ~or mpr~na~c of ~c ~cr or ~, ~d ~s d~y au~o~d m ~do~ or ~vc ~o~cd ~c ~d worL ~d to ~t ~c ~ ~] ~ ~o~ed ~n ~e m~ scl fo~ ~ ~c app]Jca~on ~cd h~. NOTA~ ~BLIC, Slate ~ N~ Y~ Sworn to ~[orc mc No~ ~b~c: FORM - 06110 3. Nature of work (check which opplicoble)~ New Building ..... Addition .................. Alteration ............... Rep,air .................... Rereo~ .................... Demolition ...............,.~ Other Work (Descr be) ~ 4. ~ .................... ,..m? ................................ rea ........~ ...~,:...'T...?.. .............................................. .~ ............. 1 (to be paid on filing this application) 5. If d~,elling, number of dwelling units ............ /. .............. Number of dwelling units on each floor ............................ If g?age, number of oars ........................ ~ .......................................................................................................... 6. If business, commercial or reixed occupancy, specify nature and extent of each type of use .............................. 7. Dire~nsions of existing structures, if any: Front .......................... Pear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................ ... Dim~ensions~ of same structure with alterations or additions: Front ................................ Rear ........................... Depih .............................. Height .............................. Number of Stories ........................................ 8. Dire~nsJons' of entire new construction: Front ....... ~...~.,. ........... Rear .....~....~... .............. Depth ....'~'......~. ............ Heklht ............................ Number of Stories ............................ 9. Size of rot: ~ro, t Z ..C;~... ............. R~r ..,.,/...~. ,O. Depth ...~...~.,.e. .................. ~0. Oa,~ o~ Purehos~ Z~.~..~. ....... ~.....~... ......... Name of ~a~er O~ne, ....~.~.~..~./. ............ 11. Zon~ or use district in which premises are situated ......... ~ ................................................................................ 12. Doei proposed construction violate any zorjing law, ordinance or regulation~ Z~. ~ Noree of Architect .,,,,,~,.,~ ........................................... Address ............................................ Phone No ................. Nar0e of Contractor ....~./.').~.Z~....~...~...-.,.,~..~.-~.~...Address/~.~.,/.'..A~....~....~..,..?.o.R'~...~.~F~one No~.~.. ~'~' PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property li~es. Give street and block numbers or description according to deed, and show street names (3nd indic, whether in~erior or corner Jot. op~ ~ 0 STATE OFiNEW~i~O,I~,,/,.,. ,~ ~. / ........ ~.'... duly sworn, depose~ and says that he is the applic (Name of above ~ed., He is the (Contractor, agent, corporate officer, ~c.) of said owner or owners, and is ~ly authorized to perform or hove performed the said work and to make a~ ~le this application; that all statements contained in this application are true ~o the best of his knowledge and beHJf; and that t~e work will be performed in the manner set foffh inethe applicatmn filed therewith, Sworn to bbfom me this I' , // , ..... ~ ~o~o, ............. ~ ..... ~A~/~ ;,,, ~ ~. ' ' ~ m_ ~ ~ ~~ ~ .,.~~~....~..~..~.~.~_~.......~[... Notary Public,~.~,.~.~~o~n~o~e~ ~l~o s~te al ~ew(~nature of applicant) '.~ ~m Shelter Island Design & Build, Inc. 11 Stearns Point Road, Box 363 Shelter Island Hts., NY 11965-0363 Lic # 16,283 HI SI Lic # 232-R October 22, 2010 Richard Lacey 631-734-2429 txrijoyce@yahoo.com Project: 1050 Robinson Lane Peconic, NY 11958 Office (631) 749-1870 Fax (631) 749-1641 Cell (631) 831-2625 Footin;I & straDoin~ / ! CERTIFICATION OF i NAILING & CONNECTION'~ REQUIRED. ~ OCCUPANCY OR LISE IS UNLAWFUL WITHOUT CERTIFICAT OF: ,...,_,,.,Ut AN_ ¢ RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE, / H~ ~_¢'- CO~!PLY W!';'H ALL CODES OF NEW I~'ORK STATE & TOWN CODES ,,....¢,.~.,I~E(~JIRED'ski-4D COND;TiONS OF UNDERWRiTERS CERTIFICATE ,,- SOt:~IO~TO',h'N~,, ,t,/ / pos'T S APPROVEDASNOTED ~ O~ LOWING INSPECTIONS: 1 F©ONDATION- TWO REQUIRED F o R POURED CONC~ lb ~ ~O~GH*F~ING,~U~I~, STRAPPING ELECTRIC~ & CAULKING 3 INSU~TI~ 4 FINAL - CONSTR~TION & E~C~IC~ MUST BE C~ F~ C.O. ALL CONS~TI~ ~ ~ ~ .4~EQUIREMENTS OF TIlE COl)ES OF NEW ~K STATE. NOT -4"