HomeMy WebLinkAbout35921-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34626
Ik~te: 10/25/10
THIS CERTIFIES that the building DECK
Location of Property: 1975 SKUNK LA CUTCNOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax~4ap No. 473889 Section 97 Block 4 Lot 9
Subdivision Filed Map No. __ Lot No. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 30, 2010 purs,,ant to which
Building Permit No. 35921-Z dated OCTOBER 6, 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.
Ge certificate is issued to 9L~RIE FICHT
of the aforesaid building.
(OWNER)
SuF~OI~K CO~FTY DEPART~4ENT OF HEALTH APPROVAL
~,R~-£KIC3%L CERTIFICATE NO.
PLD]~BERS CERTIFICATION DA'r~u
Rev. 1/81
~/A
N/A
N/A
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. 35921 Z Date OCTOBER 6, 2010
Permission is hereby granted to:
DOLORES CLARKE ~'~-~;~
1975 SKUNK LA
CUTCHOGUE,NY 11935
for :
"AS BUILT" DECK ADDITION TO AIq EXISTING DWELLING AS APPLIED FOR
at premises located at 1975 SKUNK LA
County Tax Map NO. 473889 Section 097 Block
pursuant to application dated SEPTEMBER 30, 2010
Building Inspector to expire on APRIL 6,
CUTCHOGUE
0004 Lot No. 009
and approved by the
2012.
Fee $ 560.00
Aufhorlzed Signature
ORIGINAL
Rev. 5/8/02
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAN£
OCT 1 5 20',0
BtDG. DEPI.
TOWN OF SOUTHOLD
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:
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 inspect signed by the applicant. Ifa 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 $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, Commercial $15.00
Date.
New Construction: Old or Pre-existing Building:
LocationofProperty: ~ qT~'
House No. Street
Owner or Owners of Property: POI 0/~ ¢ .~
(check one)
Suffolk County Tax Map No 1000, Section
Subdivision
'77
Permit No. 3,~' ~2
Health Dept. Approval:
Date of Permit. lO ~' tf '/0
Block
Filed Map.
Applicant:
Lot t~
Lot:
Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ :~ff
Final Certificate: [~ (check one)
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN~TION
[ ] FRAMING / STRAPPING [ t/~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ]FIIEIIESISTAHTCO#STRUCTION [ ]FLqEIIESISTANTPEHETIIATIOI4
DATE
INSPECTOR ::~·
TOWN OF SOUTHO
BUILDING DEPART
TOWN HALL
SOUTHOLD, NY 119
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. Northl
1SEP 30 2010
BLDG. DEPT.
$;
Examined ?O/ff , 20 /O
-/
Approved /O/t~, 20/0
Disapproved a/c
Expiration
Building Inspector
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
Storm-Water Assessment Form
Contact:
Mail to:
Phone:
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date ~t~L 30 ,20 IO
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, andj,~a'flmit
authorized inspectors on premises and in building for necessary inspections. / f ~
~ ature of ~plic~l~ name, ifa corporation)
(Mailing add[ess of applicant~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises P~/tOt'~5
(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.
1. Location ~d~em~hi*~~k will be done:
House Nmb~'°** '"'~ '~'* gtr3gt"'~
Co~ty T~ Map No. 1000 Section q ~
Subdivision
Hamlet
Block ~_
Filed Map No.
Lot ~
Lot
State existing use and occupancy of premises al~d intendqd use and occupancy ~..,.~joposed construction:
' Z ,~ :
a. Existing use and occupancy /{ ~ 5! tg/8~ ~' *"
b. Intended use and occupancy ~/ ~ c ~
Nature of work (check which applicable): New Building.
Repair Removal Demolition
4. Estimated Cost
5. If dwelling, number of dwelling units
If garage, number of cars
Addition
Other Work
Fee
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.
7. Dimensions of existing structures, if any: Front 7,2-- Rear q 2~ Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth Height. Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size oflot: Front ~0 Rear ~,~-. Depth ~'~'/, ~.~ '
Rear
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 NO
14. Names of Owner of premises
Name of Architect A,r~trl ~
Name of Contractor
Address Phone No.
Address Phone No
Address 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 X
* 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:~'~)~ )
/~)0 1 ,r.'/L'- ~ ~t'/,r '"')L' being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the ~.~ri ~
(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 filed therewith. I~t~ ~. ~IIg~W
204?
NOTARY I~UBLIC-$TATIE OF NEW
No. 02MC6131814
Applicant
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
Item Number:
PROPERTY LOCATION: S.C.T.M. #:
District Section Block Lot
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OFA
STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL pLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW yORK.
(NOTE: A Check Mark (,~) for each Question is Required for a Complete Application)
Yes No
1
2
3
4
5
6
7
8
9
Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site?
(This item will include all run-off created by site clearing and/or construction activities as well as all Site
Improvements and the permanent creation of impervious surfaces.)
Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFIow!
Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards of Material within any ParCel?
Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Surface?
Is there a Natural Water Course Running through the Site?
Is this Projec~ 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 Vedical Rise to
One Hundred (100') of Horizontal Distance?
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off
into and/or in the direction of a Town right-of-way?
Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of
any item Within the Town Right-of-Way or Road Shoulder Area?
(This item will NOT include the Installation of Driveway Aprons.)
Will this Project Require Site Preparation within the One Hundred (I00) Year Floodplain of any Watercourse?
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 Issuance of Any Building Permit!
EXEMPTION: Yes N~o
Does this project meet the minimum standards for classification es an Agricultural Project?
Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requiredl
STATE OF NEW YORK,
COUNTY OF .........
That l,. j~O.l~..~...t'..~/'~ ........ ~..~.h.~s..~.~.~...~' ................. being dui,,, sworn, deposes m~d s;t;'s that he/she is fl~e applicam t~n Pe,anit,
(Name of individual signing Document)
And that he/she is the ....................................................... ~...~...'~...~}.....~... ................................. ' .................................................
(Owqer, Contractor, Agent, Corporale Officer, etc)
Ovmer and/or representative of the Owner of Owners, tnd is dt ly authorized to perfor n or bare performed fl~e said work ;u~d to
make and file this application; tb;tt ~dl statements contained in this applicafioD are true to the best of bis knowledge and belief; and
that tJ~e work will be performed in the manner set forth in the application filed herewith. I~'~ ~. I~I~W
Sworn to before me this;
.......... Z..[I'77. ...................... day of~tff/J ....................... 20.?,,1~
Not,try eubtic ...~..... /~ ~~
NOTMY IqI~uC.IMN O~ mW ¥OmC
NO. Q~M~41~t&14
FORM - 06/07
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CLIENT INFOPJ"IATION DISTRI6T:
FIT¢H P. ESII2EN6E 5EE, TION
Nemschick Silverman Architects P.C.
" . [he business of A~CHITECTURE"
430 Green Way, Cutchogue, New York 11935
Phone: 631-734-7007 Fax: 631-734-7347
http ://VV~N. ns-a rch. corn
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O~CUPANCY OR
U~E IS UNLAWFUL
~ITHC',~ iT CERTIFICATE
OF ~""' "::~,~kF~V
'r"'&PC ~4G ELECTRICAL & CA ' ~qG S~ REVISIONS/SUBMISSIONS: DRAWING TITLE:
¢ DIS,lOT' ~CT,O, BLOCK: LOT' DRAWN BY.