HomeMy WebLinkAbout34303-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34718 Date: 11/30/10
THIS CERTIFIES that the building SCREENED PORCH
Location of Property: MADELINE AVE FISHERS ISLAND
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 6 Block 7 Lot 12
Subdivision Filed Map No. Lot NO.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 18, 2008 pursuant to which
Building Permit No. 34303-Z dated NOVEMBER 18, 2008
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 SCREENED PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to LOUISE BURNHAM PACKARD & ORS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
�.uth ized ignature
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 UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 34303 Z Date NOVEMBER 18 , 2008
Permission is hereby granted to:
LOUISE BURNHAM PACKARD
26 DEXTER RD
LEXINGTON,MA 02420
for
CONSTRUCTION OF A PORCH ADDITION AS APPLIED FOR. THIS PERMIT
REPLACES 31838 .
at premises located at MADELINE AVE FISHERS ISLAND
County Tax Map No. 473889 Section 006 Block 0007 Lot No. 012
pursuant to application dated NOVEMBER 18 , 2008 and approved by the
Building Inspector to expire on MAY 18 , 2010 .
Fee $ 150 . 00
Au o ' zed Signature
ORIGINAL
Rev. 5/8/02
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. 38 Z Date MARCH 10 , 2006
-11
Permission is hereby granted to :
LOUISE BURNHAM PACKARD
26 DEXTER RD
LEXINGTON,MA 02420
for
CONSTRUCTION OF A PORCH ADDITION AS APPLIED FOR. THIS PERMIT
REPLACES #10244Z & 28645Z .
at premises located at MADELINE AVE FISHERS ISLAND
County Tax Map No. 473889 Section 006 Block 0007 Lot No. 012
pursuant to application dated MARCH 10 , 2006 and approved by the
Building Inspector to expire on SEPTEMBER 10 , 2007 .
Fee $ 150 . 00
Au o z Si nature
ORIGINAL
Rev. 5/8/02
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)
\ n ry
PERMIT NO. �5 Z �1I ] Date AUGUST 12 , 2002
Permission is hereby granted to:
STEPHEN T & ORS BURNHAM
ARLINGTON,MA 02174
for
CONSTRUCTION OF A PORCH ADDITION AS APPLIED FOR. THIS PERMIT
REPLACES PERMIT # L L110
at premises located at MADELINE AVE FISHERS ISLAND
County Tax Map No. 473889 Section 006 Block 0007 Lot No. 012
pursuant to application dated AUGUST 12 , 2002 and approved by the
Building Inspector to expire on FEBRUARY 12 , 2004 .
Fee $ 150 . 00 IL�
Author d ature
ORIGINAL
Rev. 5/8/02
Form No.6
TOWN OF
BUILDING DEPARTMENT
NT Q
TOWN HALL
765-1802
o
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the I ing: o
A. For new building or new use: o
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusu I nat ral or Tu:�
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, s rertificate
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 the reasons therefor in writing to the applicant.
C. Fees
I. Certificate of Occupancy -New dwelling $25.00.Additions w dwelling$25.00,Alterations to dwelling$25.00,
Swimming pool $25.00. Accessory build;a $25.00, AdGitions to accessory building$25.00, Businesses $50,00-
2. Certificate of Occupancy on Pre-existing Buiiding - $100.00
I Copy of Certificate of Occupancy - $25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy- Residential $i 5.00, Commercial S 15.00
Date. _Se el
New Construction: Old or Pre-existing Building: (check one) nn m-I
Location of Property: h_- e t,;,4 _ rl S J Spa w�
HOIJSC Pi o. r ``,::ce11c i-;ainiei
Owner or Owners of Property: S�exo `n`3U(� -N.y_t��(.t/St0. I N kLo,*1;
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision �CJ?L�3 Piled Map. Lot: _
JJ ---- — ----- ((�� ( ------------..
Permit No. Date of Permit. Applicant:_ SfCpLe�
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: 'Temporary Cert-fcate (check one)
Fee Subm-tied: $ �S Cq)
1 ;� f- ----- - )4 Ig
I< -7 l73 --App ntSignature —
t -
Y���oYl
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(1ST) - -
------------------------------------
--- - T C
FOUNDATION (2ND)
z
0
y
ROUGH FRAMING& y
PLUMBING -
H
INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
O
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Z
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9g9i;1 �0� 5 IyT✓ BOARD OF HEALTH . .. . . . . . . . . . . . .
�_�,,�_ FORM NO. 1 3 SETS OF PLANS .
DG.S� DEPT.6 — BLDG.DEPT. OWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
(�f UTNQt� r�;yOPSOUTHOn n LDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . .. . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . .... . . . . .
SOUTHOLD, N.Y. 11971
TELL yy76665-1802 NOTIFY:
J�� ✓ � .L, CALL J 1�:7`f.. . . ... .. ...
MAIL TO 1- � � -•r'
Examined.................. 19.... `'J ,,,L`. i t _(� . . . . . . . . . . . . .
, 19.... Permit No. L .. 1.7../P .. .
Approved.............. .. .....................- \
Disapproved a/c ! S61tiY5
...................................................... (( Oi✓ 9�4 call l`Ol to (lv'�I°1'�
c.lti,.cwk-y�,
(Building Inspector) �-S Ou it� v
APPLICATION FOR BUILDING PERMIT
Date.7qUly;k . . . . . . . . 19.9 9
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wi
3 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 giving a detailed description of layout of property mist be drawn on the diagram which is part of
this application.
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
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 whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATICN IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zane Ordinance of the Town of Southold, Suffolk Canty, 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
regu*tions, and to admit authorized inspectors on premises and in building fgr p@Q ssa 1 inspeytions. "
Axed
(�i of licannt, or name if a corporation)
�px s sl �1y 66s 0
. . ..... ........... .. . .. . ....... .......
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
l.J Y12� IO .
Nam of owner of premises �2 ke 7 (�tllnn�4w� lGfnq �1L.�}!t!y +y ',4�Aa �Q�j( `
(as on the tax roll or latest deed) 1Jo;/,FX
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 Trades License No. ...................
1. location of land on which proposed work will be done..............................................................
feli�<..��c.............................Fi��ie(s.Zsl� ..............
House Neer Street Hamlet
Canty Tax Map No. 1000 Section ....OG 6...... Block ......P.7..... lot .......
Subdivision ...................................... Filed Map No. ............... lot .....:.........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...-SAaSowe,�..4'� ��.. any..,�1...........................................
b. Intended use and occupancy .......5c.t.am...............................................................
.. - ...._.... .n .......... ......mama ..x..... ...aeaBuuui ..........
Repair ............ Removal ............. Deoolition ............ Other Work ..................................
,(/ (Description)
4. Estimated Cost iZ.20y.�............ fee ..............................................
(to be paid on filing this application)
5. If dwelling, number of dwelling twits Numf)er of dwelling units on each floor .& .
nog ............ g ................
Ifgarage, number of cars ...........0 ........................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.....'-'..............
f t
7. Dimensions of existing structures, if any: Front......ZO..t...... Rear .... .......... Depth ...347...........
Height ........30.............. Number of Stories .....R.............�7. 7
Dimensions of samestructure with alterations or additions: Front .....ai.`s...... Rear ..... .......
Depth 13 je`. t
......... ..... Ner�ht ......�4........... Nunioer of Stories .....Z........
a �
8. Dimensions of entire new construction: Front ....!.�......... Rear .....A) ...... Depth .... pQ......
a
Height ..........(r............. Number of Sttories .....I...............
9. Size of lot: Front .................... Rear ....................LDepth ....................... M SWvh.l o.1YitA d
►`10. Date of Purchase . � (-IlX jl�!...... Name of Former Owner .. J ? i ...�c- Qt1!0` j t ...........
11. Zane or use district in which premises are situated .. (tS i�tivr
12. Does proposed construction violate any zoning law, ordinance or regulation: ..^.0..................
13. Will lot be regraded ........nl*......... Will excess fill be removed from premises: LL --YES ---•tr-
14. flames of Owner of premises StY�l.". I(y�4h,Qu[ta�laa!ti Address _fy A)AktSr: A(t' 5fw_ hA. l ,e No.u
r
Name of Architect .................................... Address .............................. Rhone No. ..............
Name of Contractor ................................... Address ...............................Phone No. ..............
15. Is this property within 300 feet of a tidal wetland? * YES .......... NO ..X.....
*IF YES, SWn D TOld1 TRDSIM FUMrT MAY BE WgAR®.
PLOT DIAGRAM
Iocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or F6iillr lot.
i
Dec k
rM
t
E,Va used
AJA
spa. aklaau�
5�
S NIE of NW Yuw,
SS /
OOUP7IY OE ..?5.!t�t?�K...........
RR i
••� �h '•••v-•-•PA4• .....r..............being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named,
Ileis the ........ !2 e✓►�.............................................................................
(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.
Swum to before me this II
.......L8�......day of ...s11� QQ .......19.4if....
Notary Public
................
MARY ELPANKIEVACL �/ ..can t
EOM d�ax, STATE OF l4AI 't (Signature of Applicant)
All. llYe?b7Bu0- `
{�_ &M EVIRS 64 1 3eI700U
QFFO( Town Hall
Albert J.Krupski, President
James King,Vice-President ��0 (jy 53095 Route 25
Henry Smith c P.O.Box 1179
y Southold,New York 11971-0959
Artie Foster
Ken Poliwoda ® Telephone(631)765-1892
Fax(631)765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
August 24, 2000
Mr. Charles VanVoorhis
628 Pleasant Street
Suite 322
New Bedford, MA 02740
RE: LOUIS BURNHAM PACKARD
Madeline Ave. , Fishers Island
SCTM#6-7-12
Dear Mr. VanVoorhis :
The following action was taken by the Southold Town Board of
Trustees at their Regular Meeting held on Wednesday, August 23,
2000 :
RESOLVED, that the Southold Town Board of Trustees grant the
request for a Waiver to LOUISE BURNHAM PACKARD for the addition
of a 18 'X 18 ' sunroom and a 18 ' wraparound deck.
This approval does not constitute approvals from any other
agency.
If you have any questions, please call our office at 765-1892 .
Sincerely,
�.
Albert J. Krupski, Jr.
President, Board of Trustees
AJK: lms
-Q.k•` %fir' `7 !i'.� `. �:�t��1 u, s 1�T ,�'�'•r f .-j�'..,�.��� ...
w ' ,41-D2.4(r/94)—Ilse - F -
X�.,' "New York State
Department of Environmental Conservation
Order On Consent/Stipulation
New York State Environmental Conservation Law
Number #,4-•}
(Respondent) (Street and Number)
of 4 �'`i r) hereby pay to the Department
(Name of Town, Village,City and State)
f �.
of Environmental Conservation of the State of New York the,sum of 1_5 dollars
41 agree tv striet}y crompty-with-the-oonditien -xyre-6chedtile-A tc^and
made a part hereof,'by reason
ason of my act consisting of �1i=44i c�f-
A__tr-,rnit _c.-u
the same being a vi ation of Section /of the State of New York's
Environmental Conservation Law and/or Section I,r1-ti'~ 10 62 of the State of New
York's Rules and Regtilations,,6'NYCRR, said act committed in
(f (name of town, village,city)
County of �`-)€•�{I L. State of New York on
In so stipulating, I waive my right to a hearing in this matter.
Respondent's Signature' �p Respondent's 7itle(If COoration)
-. ,; ...f ..:..._. 1 .
{;L
Dated: ' •"l i ' + 13 Location. , NY
(month,day) (name of town, village,city)
' NOTE: If consent order/stipulation is against a corporation, the respondent must bean official,
authorized, corporate representative.
This or ti u ation has bee v wed by:
'-Pant Name and Title of DLE Official Date Signature
WHEREAS:
having violated Sections f ? / of the State of New York's
(Respondent)
Environmental Conservation Law and/or SectioA/4 L';03 of the State of New York's Rules
and Regulations, 6 NYCRR, at the time and in the manner stated above, and having waived the
right to a hearing on the violation(s)and having offered to pay the sum of !v 40, dollars
by reason of said violation, and after due consideration having been had thereon it appearing that
this order will be advantageous to the State, now therefore,
IT IS HEREBY ORDERED,pursuant to the provisions of the Environmental Conservation Law,that
the offered sum shall be paid to the Department of Environmental-Cong�ervation as a penalty for
the violation described above and Respondent shall comply with the terms of the attached Schedule
A by reason of such violation.
i Sign_ed
` Regional Director,for the Commissioner
^2 t•� / �i r r(/
Dated / "I('S % / }9"_ 'Location: -1.J� n Lr � ,d, �.� NY
>,I(month,day) f (name of town,village,city)
t;
TOWN OF SOUTHOLD P40PERTY RECORD CARD ;
OW14ER STREET VILLAGE DISTRICT SUB. LOT
FORMER OWNER N E ACREAGE '
lltl)/, Kow ( f , _� I r. --
Nlr >/��X!! 4 r1/'b� S W //_� r TYPE OF BUILDING
L - /i I t1 LT, //,v.�P;v7%.r.-f d
RES. uZ/ 6 SEAS. VL. FARM COMM. I IND. I CB. I MISC. I Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
--=f� It'-A1P. .is 66U. - IC - `F'r+t �a�K9tYe-%- I. Lf(7
/l ,a
AGE BUILDING CONDITION �� / CI�115 #51_ CI � ep - rin Ors �?
NEW NORMAL BELOW ABOVE FRONTAGE ON WATER �� (C �ra 13 1, ..rf. .• e'{ k ! w,(.
Farm Acre Value Per Acre Value FRONTAGE ON ROAD �-
r,c co
Tillable I BULKHEAD 6 �a� _CDr7sXa �neE - �
Tillable 2 DOCK
Tillable 3
Woodland
Swampland
Brushland
House Plot
Total
ya
j
MW
i
I �T�
i r �
A Bldg.k � �, �� e� SLU Foundation j �'f � Both r
Extension X� Basement F Lj I Floors r ✓ - — — -
Extension , r rc-�/ 20a(e2-
a Ext. Walls „/ Interior Finish (�el -
Extension Fire Place t
eat l�(
—---- - - - - (I t t1 r
i �
Porch Roof Typelyy /
Porch Rccros 1st Floor
Breezeway Patio Rooms 2nd Floor
—- -- —
Garage Driveway � Dormer �-
I I
� � J
2yzft. 6 •
.a v
41
Ne J ConS�t�c�' w\ `F
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Ne� 1 El
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PP vc�h
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97.80 "f t
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PT cx- 7->ey PT - Sep" rn IY\ Yc� ' ' '�4,6 � � QvfA�o fy) �l"1all0y +_ar-
Se+ ; n co,nc cete J PC ,
la�e� � n'f'o Sf'�ne �ounc�a�`iaYl
Cec-� P-T
IS FUL
F -- -- --------
UNDERWRITERS CERTIFICATE
REQUIRED
PT --
i
— -- _— - -
rSxS � � C_eaar
I NSF
ALFRED R. GREBE, JR.
N 864440" E
620N PIPE 'l
MERESME
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NOTES:
PIRATE COVE MARINE '""' 1.) COORDINATE DISTANCES ARE MEASURED FROM U.S.
COAST k GEODETIC SURVEY TRIANGULATION STATION
`PROS'
AREA= 2.26E ACRES 2.) TAX REFERENCE:
DISTRICT 1000, SECTION 006, BLOCK 7, LOT 12
N/F MAP REFERENCE:
PATRICIA DOWNEY -
PLAN OF PROPERTY PREPARED FOR RALPH E. AND
ROSALIE ROOKS FISHERS ISLAND, NEW YORK , MAY 1966
DECK CHANDLER g PALMER SCALE: 1`-40'
S 8736'00" IN
HOUSE 72.80' "
N/F EXISnNG SURVEY MAP
GALILEO VALENTINI WALKlu�s�6s PREPARED FOR
W 626.27
GDY WIR GEORGE W. PACKARD ,
w LOUISE BURNHAM PACKARD;
N ERESTONE
OF NEW y'o YP .
yP N.srAOL � STEPHEN T. BURNHAM
LE# 162 ,.
sm RANT
CORNELIA B . BURNHAM
3 Ja AVENUE
as zG aG
0 ISFERS-ISLAND,' j
GRAPHIC SCALE IN FEET NEu! ,PORK _
y w�
aed! PIPE h �J -
tl
REVISIONS O1-IA.IVDLER4 . Pi1.LIWEMt ds Kirild
DATE DESCRIPTIONArch
Itmt.l p
�ID110M1• EMd11MbL CI a710 tl�p-�.�lFAY�10-i1�01 �,'
GEORGE W. PACKARD,-LOUISE .BURNHAMI PACKARD. POLE) 151� / 9
SEkf'H FI_ _ AM CORNELIA B, BURNHAM, \\}j
FIRST OA TITLE INSURANCE COMPANY OF NEW YORK AND
CHA MAHFI �'TAN4 Lftw
1H'A A7�I' WITH THE .MINIMUM STANDARDS FOR
- . TITLE SURVEYS OF THE NEW YORK STATE LAND TITLE DATE: AUGUST 11 , 1999
ASSOCIAT1k K TITLP # 151=S-0772 SCALE: 1" = 40' _
SHEET I OF 14
3
a
N/F
ALFRED R. GREBE, JR.
I
N 86-44'40" E
242.60'
IRON PIPE
MERESTONE
Z
w o,
a
J uJ_
J O O
N
N O
N O
AREA= 2.26t ACRES
m
NYS'OEO FRESHWATER WETLAND NOTES:
N/F 'BOUNDARY ASJFLAGGED BY
PIRATE COVE MARINE C. BALK N.Y.S.D.E.C. 3/15/00 _ 1.) COORDINATE DISTANCES ARE MEASURED FROM U.S.
W.F. COAST & GEODETIC SURVEY TRIANGULATION STATION
"PROS"
WF. 2.) TAX REFERENCE:
DISTRICT 1000, SECTION 006, BLOCK 7, LOT 12
N/F MAP REFERENCE:
W.F. PATRICIA DOWNEY
\\�� EXISTING PLAN OF PROPERTY PREPARED FOR RALPH E. AND
LAWN AREA ROSALIE ROOKS FISHERS ISLAND, NEW YORK MAY 1966
WF \,\, DECK CHANDLER & PALMER SCALE: 1"=40'
PATH
W.F. HOUSE
S 87'36'00" W
-_ W.F. 72.80'
\
N/F = W.F,-
MICHAEL LAUGHLIN - _ =-W.F. W.-_- IRON PIPE SURVEY MAP
_-- \ WALK N 4313.0s PREPARED FOR
W.F. \ W 626.27
2 GEORGE W. PACKARD ,
\� = EXISTING DRIVE
, OUISE BURNHAM PACKARD ,
a` W.F.WF MERESTONE
POLE 152 STEPHEN T. BURNHAM ,
# j
HYDRANT _ -_ -, --� C O R N E L I A B . BURNHAM
40 20 V 0 a0 MADELINE AVENUE
�"p P GRAPHIC SCALE IN FEET FISHERS NEW YORK ISLAND,
IRON PIPE 5 v
O�
�P REVISIONS _ M M CHANDLER, PALMER Sc KING
DATE DESCRIPTION
MAW
r 3 17 00 ADDED WETLANDS Architecture, Engineering and Surveying
POLE 151 nO BRO.ADWAY NORWOH, CT Oexa ee0-809-3 T FAX eeO-eee-7501
DATE: AUGUST 11, 1999
SCALE: 1 " = 40'
SHEET 1 OF 1
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