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HomeMy WebLinkAbout36094-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY 8/11/2011 No: 35130 Date: 8/10/2011 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: RESIDENTIAL ALTERATION 615 Pike Street, Mattituck, Sec/Block/Lot: 140.-2-21 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 9/20/2010 pursuant to which Building Permit No. 36094 dated 1/10/2011 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: alterations and renovation to an existing one family dwelling: first floor only, single family occupancy, second floor unfinished. The certificate is issued to Olde Colonial Place LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36094 5/9/11 thy pex u~_~sed- no sol~der 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. 36094 Z Date JANUARY 10, 2011 Permission is hereby granted to: OLDE COLONIAL PLACE LLC 615 PIKE ST MATTITUCK,NY 11952 for : ALTERATIONS TO RENOVATE AN EXISTING DWELLING TO A OWNER OCCUPIED FAMILY DWELLING AS APPLIED FOR at premises located at 615 PIKE ST County Tax Map No. 473889 Section 140 Block pursuant to application dated SEPTEMBER 20, 2010 Building Inspector to expire on JULY 10, MATTITUCK 0002 Lot No. 021 and approved by the 2012. Fee $ 1,780.80 ~ Signature ORIGINAL Rev. 5/8/02 Form No. ~ 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 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: 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. Certi~cate ~f ~ccupancy ' N~w dwe~~ing $25.~~~ Addi~~ns t~ dwelling $25.~~~ A~terati~ns t~ dwe~~ing $25.~~~ 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: Old or Pre-existing Building: House No. Street Owne orO nersnfPrope *: (check one) Suffolk County Tax Map No 1000, Section Subdivision Permit No. ,ri.--- Health Dept. Approval: Planning Board Approval: Request for: [,d~ Block _t~. Lot ~ Filed Map. Lot: Date of Permit. Applicant: Underwriters Approval: --' .... Temporary Certificate Fee Submitted: $ Final Certifica~ ~ Town Hall Anncx 54375 Main Road P.O. Box 1179 Southold. New York I 19714)959 Telephone (63 1 ) 765-181)2 Fax (631) 765-9502 ro.qer, richert~,town southo d ny us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Olde Colonial Place, LLC Address: 615 Pike St City: Mattituck St: NY Zip: 11952 Building Permit #: 36094 Section: 140 Block: 2 Lot: 21 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Peconic Electric Corp LicenseNo: 5230-me SITE DETAILS Office Use Only Residential ~ Indoor J~ Basement ~ Service Only ~ Commerical Outdoor 1 st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ CeilingFixtures J~ HIDFixtureSr~l~ Service 3 ph Hot Water GFCl Recpt Wall Fixtures Smoke Detectors Main Panel NC Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel NC Blower Range Recpt Fluorescent Fixture I I Pumps Transformer Appliances Dryer Recpt Emergency FixturesJ J Time Clocks Disconnect Switches Twist Lock Exit Fixtures L~J TVSS Other Equipment: dedicated 20a line for dish washer, 3-paddle fans, 2-exhaust fans Notes: Inspector Signature: Date: May 9 2011 81-Ced Electrical Compliance Form CERTIFICATION Date: ]--10 - / / Building Permit No. (Please prin~) Plumber: (Please print) lead. Sworn to before me this ..,~ ,,~ ~w~, ............ ~a~v~ supply ayalvm comuins less day of ., 20__ Notary Public, County TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECT/ION [ ] FOUNDATION 1ST [~ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SA,-.' ~'f INSPECTION / ~ ~ /~ I ~' /~ / - ~ / ~- - ., / DATE ~ INSPECTOR TOWN OF SOUTHO~ ILDING DEPT. INSPECT/ION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE&CHIMNEY [ ] FIRESAi-,-~'(INSFECTION [ ] FIREnEmSTANTCONSTnUCTa~ [ ] flREREmTANTF~NETR~TN)N i~ -~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]~IJGH PLBG. [,/] INSULATION ] FINAL ] FIRE SAi-,-, ~' INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ [ ] F.~RmST,~rrco. s'~'~O. [ DATE INSPECTOR~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ] ROUGH PLBG. [ ]INSULATION [ ] FINAL [ ]FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [~] ELECTRICAL (FINAL) REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] ROUGH PLBG. [ ] ~.A~ON [ ~FINAL ] FOUNDATION 1ST ] FOUNDATION 2ND ] FRAMING / STRAPPING [ ] FIREPLACE&CHIMNEY [ ] FIRESAi-..~I~INSPECTION ~RKS: - ~- ~ · DATE ~ INSPECTOR ~~~ DATE [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [. ] I~LATION [ ] FRAMING/STRAPPING [~ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [] ELECTRI~/R_OUG~H), ~O[.]4~LEGTRIGAL (F~INA//~ FA~MARKS! - INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY P~I:IRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ( ] ELECTRICAL (FINAL) INSPECTOR~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]~TION [ ]FRAMING/STRAPPING ['//]~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) REMARKS: [ ] ELECTRICAL (FINAL) DATE ~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ~._/NS~ON [ ] FRAMING/STRAPPING [~'I=INAL [ ]FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ]RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENEllMTION [ ]ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) DATE INSPECTOR Christopher R. Stress, R.A. Architecture and Planning 631-722-7865 New York 610-899-0157 Pennsylvania runabout(~ptd net 12 April 2011 Town of Southold 54375 Rte 25 PO Box 1179 Southold, NY 11971 RE: Olde Colonial Place LLC 615 Pike Street Mattituck, NY Building Department, We are writing with ,r, espect to the above referenced property. The building as renoyated was constructed with 5/8 'sheetrock (gypsum wallboard) barrier between the 1 st and 2na floor. In addition, the stairwells will be fire-rated with 5/8"sheetrock and the doors at the stairwell are self closing and have a 1 hour fire rating. Only those walls disturbed received new insulation to code. Other walls and ceilings received new Sheetrock over the existing plaster. Additionally, the plumbing installed was done according to current code. The above work items were reviewed and as such, are approved by this office. Should you have any questions.oa.t,t~ove or current status of work on contact this office. B t Regards, Christopher Stress, R.A. CC: Edward Broidy, Olde Colonial Place the project site, kindly TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net PERNHT NO. Exphation "~/0 ,2o [eq'- BUILDING PERMIT APPLICATION CHECKLIST Do you have or ncexi the foHovfmg, before applying? Board of Health Planning Board approval Survey Check Septic Form Flood Permit Contact: Building Inspector Date ,20__ INSTRUCTIONS y fdlad in by typewriter or in ink and submitted to the Building Inape~tor with 4 to schedule. ,d of buildings on premises, relationship to adjoining premises or public streets or , not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a BuildMg Permit to the applicant. Such a permit shall be kept on the premises available for inspection flu'oughout the work. e. No building shall be occul~led or used in whole or in part for any propose what so ever until the Buildin~ Inspector issues a Certificate of Occupancy. £ Every building penmt shall expire if the work authorized has not commenced within/2 months after the date of issuance or has not been completed within 18 months fi.om such date. If no zoning amendments or other regulations affecting the property have been enacted in the interhn, the Building Inspector may authorize, in writing, th{: extension of the permit for an addition six months. Theamflor, a new permit shall be r~quired. APPLICATION/S HEREBY MADE to the Building Depa~mcnt 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 baildings, additions, or alterations~.~moval or dam(l~m,~erein described. The applicant ~ to comply wi, all apl~li~ab!e ~ws, ordinances, ~ui¥ffng cad~,~g code. z.__a~ns, and to admit authorized respecters on prcmtses and m Inulding for ncc~sary tnRons. ~.) ) ~ ~~) ~ (Signature of applicant or nme, if a corporation) State whether applicant is owner, lcssoe, agent, architect, engineer, gcnerul contractor, electrician, plumber or builder ~.~ Name of owner of premises If a~licant is a comoratio~n, signature of duly authorized officer (Name and title of corlx,rate officer) ] X: Builders License No. El¢ctri¢ian~ Lieen~e No, ~/-/~ ~ ' ~ ~"-- i. CT? d o. which wi::. orte: House NamMr Street co a X MapSo. 1000 {4D Subdivision (As on thc tax roll or latest, deed) Hamlet 0z Filed Map No. Lot LL __ 2. Stateexistinguseand~ccupancy~fpremisesandintend~duseand~ccupancy~fpr~p~sedc~nstmc~n: a. Existing use and occupancy b. Intended use mad occupancy ~"'~t~J'~/~g} Addition Alteratlon% 3. Natureofwor~(c/heckw~chappF, cable):NewBuilding Repair ~ Removal Demolition Other Work (Description) 4. E te cost 15 // .oov Fee ~, "' '- t' /t (To be paid on filing this api?icatlon) 5. If dwelling, number of dwelling units [ Number of dwelling units on each floor [ If 9araoe, number of cars Dimensions of_ existing stmctures, if any: Fmnt 4~ Rear ~ Depth 7. Dimensions of same structure ~th alterations or r -additions: Front ~ Rear ~'~'~ Depth .~.-~A.. Height ~ r~ Number of Stories Height .t~.~ .~ Number of Stories 9. Size oflot: Front t~"~ 4:' Rear [~_t~ Depth 10. Da~ of~c~ ~ N~e ofFo~ ~ 11. Zone or ~ dis~ ~ wNch pr~s~ ~ si~ 12. Does proposed constlmction violate any zoning law, ordinance or regulation? YES NO,~_ 13. Will lot be re-graded? YES NO~/N~ Will excess fall be removed from premls~? YES NO'~ of Owner of_ mi gZ No. ' Name of Archi Address~one No~ Name of Contractor (..~//m~ ~ Address -sn ~t~ tPhone No. 15 a. Is this property within 100 feet of a tidal wetland or a fieshwater wetland? *YES__NO __ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. ls this property witldn 300 feet of a tldal wetland? * YES NO * 1F YES, D.E.C. PERMITS MAY BE REQLqRED. 16. Provide survey, to male, with accurate foundation plan and distance~ to propexty lines. ~ '~OO 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 ~espect to this property. YES N * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: being duly swom, d~ and says that (s)h¢ is th~ applicant (Name of ia~g~vi~flal signing contract) above name. d, I (S)He is the , - ~t ' t * ~'~ (C&ltractor, A~nt, Corporate Officer, etc.) that all statements containexl in ~ application ara true to the ~l~t of h~ knowJ~ll~e and [~lief~[~that performed in the manner set forth in the application filed ther~itl~ [ J.q ~ day of ~ 20/0 ~.~_~__ ~ ~7 Notary Public 3~-~'~ · ! ~Wgl~l ~i~gnatu~ of Applicant NOTARY PUBLIC STARE OF NEW YORK[ ISUF~OL~ COUNW ~0 52,46633485 Town Hall A~nex 54375 Main Road P.O, Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 _Fax (631 765-9502. roqer.ricnert(~,town.southold.ny, us BUILDING DEPARTMENT TOWN OF $OUTHO~ APPLICATION FOR ELECTRICAL INSPECTION Company Name: c~-~-£Dt...~ ~"~--(.~T~ ,eL License No.: Address: Phone No.: Date: JOBSITE INFORMATION: (*Indicates required information) *Name: (~.~/~ C~L..D~L. FC,~c-~'-.~ ~l_~' *Address: ~ IS ~[~,E ~T, *Cross Street: ~t Ct~ ~ ~ *Phone No.: ~ I- ~' Goq~ Pe it No.: ? ? Tax Map District: 1000 Sec{ion: ~ ~o Block: *BRIEF DESCRIPTION OF WORK (Plea.se Print Cleady) (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (If needed] *Service Size: 1 Phase 3Phase *New Service: YEar. NO YES ~ 100 150 200 Re-connect Underground Number of Meters Additional Information: Rough In Final 300 350 400 Other Change of Service Overhead PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form ) (> ---~--c -/o TOWN OF $OUTHOLD /:o.o r~ -/,-/o SE~S. VL LAND IMD. AGE NEW , NORMAL FARM Acre Tillable Woodland MeadO~and House Plot Total To~ A~ 4000 JFARM DATE BUILDING CONDITION BELOW ABOVE Value Per Value Acre REMARKS PROPERTY RECORD CARD FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD DOCK ~ c,_ 5:' : I$o 5' ' Dr,'ST.1 SUB. LOT TYPE OF BUtLD[N~_,,.,_,~..~ · Value COLO~ Extension -' - Porch ~ Poreh W~f Breezeway Garage Patio Total Foundc~ion Basement' ~xt. Wails Fire Place :,Type Roof Recreation Room Dormer Bath Inte~or F~ni~h Heot Rooms ist Floor Rooms 2nd Floor DriveWay ' Dinette BR, CHRISTOPHER R. STRESS, R.A. ARCHITECTURE AND PLANNING P.O. BOX 821 JAMESPORT, NY 11947 PHONE/FAX(631) 722-7865 runbou~opton)ine,net MEMO TO: Building Department FROM : Christopher Stress, R.A. RE: Pike Street Property, Mattimck DATE : 10 Sept. 2010 Attached please find an application and plans and survey for the above referenced project. We would like to note that this is mainly a renovation which includes a new roof, new wall and floor finishes, a few new non-structural walls and new siding / painting. Kindly let me know the fee for the work and we will drop offa check in person. Should you have the least question, please call. Many Thanks ~O','il~ OF SOUTHOLD CHRISTOPHER R. STRESS, R.A. ARCHITECTURE AND PLANNING P.O. BOX 821 JAMESPORT, NY 11947 PHONE/FAX (631) 722-7865 runbou~optonline.net 6 December 2010 Town of Southold 54375 Rte 25 PO Box 1179 Southold, NY 11971 RE: Olde Colonial Place LLC 6 l 5 Pike Street Mattituck, NY Building Department, We are writing with respect to the above referenced property. It should be noted that the existing structure is a 3 story building. On the first two floors there are a total of six bedrooms. The inspector noted there were seven bedrooms but the room in question is on the front 1 ~t floor comer. This room is a non-heated, room with no closets. As such, not a bedroom. Additionally, we would like to point out, that as of this time, the existing sanitary system for this structure is functioning fine. However, this system is no doubt preexisting non- conforming. Should you have any questions on the above or current status of work on the project site, kindly contact this office. CC.~~lonialPlace' BI. DG. DEPT. TOWN OF SOU/HOLD CHRISTOPHER R. STRESS, R.A. ARCHITECTURE AND PLANNING Town of Southold 54375 Rte 25 PO Box 117c) Southold. NY 11971 PO. BOX 821 JAMESPORT, NY 11947 PHONE/FAX (631) 722-7865 r unbout(_o~optonline net 27 December 2010 RE: Olde Colonial Place LLC 6 1 5 Pike Street Mattituck. NY Building Department. We are WTIting with respect to the above referenced property. The building as renovated is proposed and will have a 5/8"sheetrock (gypsum wallboard) bamer between the 1~ and 2~ floor In addition, the stairwells will be fire-rated with 5/8"sheetrock and the doors at the stalrwellswfll be self closing will have a 1 hour fire rating. Should you have any ~'~llb"~' ~bove or current status of work on the project site, kindly contact this office V~ /s Reg~.~ ~~est Rega Christopher Stress. ~}~37 CC: Edward Broidy, Olde Colonial Place OLDE COLONIAL PLACE LLC 45 BROIDY LANE SOUTHAMPTON, NY 11968 (631)287-0555, FAX (631)283-2252 Januaw 7,2011 Mr. George Gillen, Building Inspector Town of Southold P O Box 1179 Southold, NY 11971 Re: 615 Pike Street Dear Mr. Gillen: As per your request, I am writing this letter to acknowledge that the current Town Code permits a two family home with the understanding that is to be owner occupied. We will abide by this stipulation. We will also abide by the current fire code as it exists now. For the edification of the Town of Southold, this building has been a two family home, with apartments on the first and second floor and an additional rental of five bedrooms with a kitchen and bathroom on the third floor for the past 60 years up to May 2010, when the last tenant moved out. Respectfully, Edward Broidy, Managing Member OLDE COLONIAL PLACE P O BOX 298 RIVERHEAD, NY 11901 (631) 287-0555, FAX 283-2252 April 19, 2011 Mr. Gary Fish, Building Inspector Town of Southold, Building Department Mattituck, NY Re: 615 Pike Street, Mattituck, NY Dear Mr. Fish: As per your recommendation let this letter point out our intent for the house at 615 Pike Street, Mattituck. The intent is to finish the downstairs apartment within the next two weeks or so and wish to receive a Certificate of Occupancy for it, which will allow us to be able to rent this apartment and to stop the bleeding of having no income. We have flied with the Suffolk County Board of Health Services for a two family and for the construction of a new septic system, as per your request. This will take 4 to 6 weeks for us to receive their approvals. After maybe another 2 to 3 weeks with the abandonment of the old cesspools and an environmental inspection; after that inspection of the septic systems and the insulation maybe we will be done in another week or so. So you can see we still have a long way to go. Once this work is all done we expect to receive the Certificate of Occupancy for the second floor and be ready to use it. As you recall, the house had two full apartments and the third floor had 6 bedrooms which were rented out weekly with a kitchen and full bathroom. The two apartments were in full use until last June 2010. This is the further intent for this property, as you have noticed, I'm sure; we have been restoring this old house to almost its original condition. Everyone seems to approve of all the work we have done to improve the house for the neighborhood. If you have any questions, please call me. Very truly yours, Edward Broidy,/v~nacJ~ffg Member / / SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR. OFFICE USE ONLY OFFICE OF WASTEWATER MANAGEMENT ~ -- 360 YAPHANK AVENUE, SUITE 2C, YAPHANK, NY 11980 I Health Department Ref. No. (631) 852-5700 APPLICATION FOR SEWAGE DISPOSAL AND WATER SUPPLY FACILITIES FOR NEW SINGLE FAMILY DWELLING REFER TO REVERSE SIDE OF TinS FOaM FOa INSTRUCTIONS AND PROPERTY OWnER/DEVELOPER'S STATEMENT PLEASE TYPE OR PRINT LEGIBLY ' Name of Applicant Telephone No. Mailing Address Name of Agent (If Not Applicant) ) ~ ~ ]Telephone No. Mailing Address Name of Current Property Owner (If Not Apphcant) -- ~' r RECEIVED Mailing Address Telephone No. ( ) Name of Surveyor, Engineer, or Architect SUFF. CO. HEALTH SERVICES Mailing Address ............... I I Block Lot TaxMapNo.: /oco /5/0 & 2 PropertyLocation~/S/EgWSideof '~J/~"/~ ~"tt, Sc-c~r /f]/~ Ff-/ To C~ , i'12-FeetN/S~::~Vof / OR N/S/EAV Corner of ITelephone No. and Subdivision Name & Lot Number (if any) Specify Method of Water Supply [~,]Publi¢ Water [ ] Private Well Proposed Number of Bedrooms Previous Health, Department Reference No(s). Hamlet Specify Method of Sewage Disposal Are any of the following permits/approvals required? (CHECK) ~] Conventional Septic System I ] Public Sewers a) Wetland pexmit - NYSDEC / TOWN? Yes [ ] No [~ If yes, include [ ] Other (explain) b) Zon ng variance - TOWN / VILLAGE? Yes [ ] No [~ copy of approval Application is hereby made for a permit to construct a water supply and sewage disposal system for a '~'l~tO family residence in accordance with this application, surveys and plans submitted. I hereby certify that I have examined this complete application and the statements therein are true and.correct, and that all work shall be completed in accordance with all applicable Town, County, State and Federal Laws and Codes. "Any false statement made herein is punishable as a misdemeanor pursu'ant to §210.45 of New York State Penal Law." Signature o/f~ppli~t / Print Name of Applicant Date ITitte IMPORTANT! SEE REVERSE SIDE FOR PROPERTY OWNER/DEVELOPER'S STATEMENT WWM-059 (Rev. 3/07) Page 1 of 2 o.n ay ~6~ ~UILDING PERMIT EXAMINER CHECKLIST kpplicant: ~~~- ~b2MM-- Owner: ~roper~Addr~s: '6 [~ ~ ~, *Date Submitted: / ~o~ lO Date Reviewed: /0-- ~ Zone: Co formiag?y - cie: luilding Permits (Open/Expired): BP ~ -Z / C/0 Z- -- , Info: ' BP -Z / C/0'z- IP__-Z / C/0 z- ,Info: BP__-Z / CJ0 Z- ,Info: BP -Z/C/0 Z- Itngle & Separate Search Required? Y ~)Determination: ~ _Z.~_, · __ ~,_~me ~. Aur.~mo__ ~,~, ~Lt,,~.Kcar,7,5'- PROP:Rear tBQ. Height ., ._zt~2~ ACT. Height ~o~ R~a~,~,,:l~St~e$ 30 ACT o~------- lyes, water body: ~ Panel# ~-~ Flood Zone: ~ Bulkhead/Biff(Distance: ' Pre COs? ~ , Info: , Info: .. LDDITIONALAPPROVALS.~ REQUIRED / ~.e_~."4~ Q.~_.oc~__r_~ ~ ~uffolk Coun~Healt~or ~ Ifyes,*Bed~: *Date: / / *Permit~ - If no, certification required: Y or N Received: Y or N By: ~S DEC: PRg-DECg/IC/S Y or~- Date: Iouthold Trustees: Y o~,~- Date: ~outhold ZBA: Y or~7 Date: /__/ ~outhold Planning: Y o~- Date: 7__ [:own Landmark C of A: Y o N~JDTE: __ t~ot~: ~-I~--t~' ~ Town Septic: Y o~ / / Permit #: Pernfit #: Permit #: Permit #: / or NJ Letter - Notes: or NJ Letter - Notes: - Notes: - Not~: ~irst Floor: ;econd Floor: 02. Other: [:otal: I 7S ~xl SFX$ ,c/v=$ +InitialFee:$ o%0o,o0 ( ):$ \~0'o SFX$,3o=$ 3~o. ac x .... ~ + Initial Fee: $ I 0 0. o o X~,~ , ~ __ ,~ C4~-. 'bb~.-C +Additi0nalFee( ):$--~ q----~. NEW YORK STATE CODE COMPLIANCE CHECICLIST CLIMATIC/GEOGRAPHIC DESIGN CRITER/A: .Grounfl Snow Load: 20. W~atherlng: Severe__..Frost Depth: 36", Design Temp: 11 · Ice Shield Underlay: YE~ . USE/OCCUPANCY CLASSIFICATION: · HttlOI:IT/FIRE ARBA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/prESCRIPTIVE FULL FR24_MING DESIGN ELEMENTS: Y/N ItEADERS: Y/N WALL sTUDs: Y/N CEILING JOISTS: YfN FLOOR JOISTS: YfN LUIM[BER SPECIES AND GRADE: Y/N Wind Speed; 120MPH Seismic Design Cat~gory:' B . Termite: M-H' ' DeCay: S-iVI l~lo~d Hazai'ds: GLR2DERS: YfN ROOF RAFTERS: YfN WINDOW A_ND DOOR SCHEDULE! IVIISSLE TEST REQUIREMENTS: Y/N EGRESS 5.7 S.F.: Y/N LIGHT 8%: Y/N ~r~NT 4%: Y/N NAILING/CONSTRUCTION SCHEDULE: Y/N MEANS OF EGrESS: Y/N PLUMBING tLISER DIAGRAM: Y/N LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N TR. USS DESIGN: Y/N CERTIFICATION: Y/lq ENERGY CALCS: Y/N TOTAL COMPLIENCE?~Y)N (RETURN TO PAGE ONE) IL. ],)TORAQ~ 137 z,~ rT MALL ,/"-" M~LL 190 ~ ~TORAQrz' II A'I-FIC ~STORAQB ,)TORAQB P SURVEY OF PROPER, TY S~TUA T£ iV[ATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S,C, TAX No. 1000-140-02-21 SCALE 1"=20' DECEMBER 11, 2009 0 On. 0 % 'x N, x, PREPARED IN ACCORDANGE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED N.Y S, L~c, No 50467 AREA 22,809 sq. fl. 0.524 ac. CERTIFIED TO. OLDE COLONIAL PLACE LLC 119 NEW HYDE PARK ROAD FRANKLIN SQ., NEW YORK FIDELITY NATIONAL TITLE INSURANCE COMPANY THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED, Nathan Taft Corw,n III Land Surveyor 29-32( SURVEY 60P¥ 0AOEP ON 0URVE¥155UED PE611,200~ BY NATHAN TA~T6OR~INIII LAND SURVEYOR " S 63'45'~0" W. '~'" / · ? NAIT,R. OAD A,'VE NUN {,F fKR STi, Et~, ) DO NOT OGALE · 7'-7 I/2" F, ITCH~N DININQ ROOM 112" D~DROOM ~ CLO}~T ~ LIVINq ROOM 3 1/2" 7'4) 35'-11 FIRST FLOOR PLAN O~,ALE: 1/4"= 1'-0" REVI01ON5 EXlSTIN~ C, ONDITIONO ~OLJTHPORT P '_.blGN IZO NO OCI~AN AVE' DAYPORT, NY 1170.5 631-419-6168 bDbINC @ OPTONLINE'.NET PROJEGT DE56RIPTION EXIOTIN~ CONDITION5 AT THO 5TORY FRAME HOUSE AKA 655 PIKE RAILROAD AVE MATTITUGK, NY 11 q52 OWNER OLDE COLONIAL PLACE 119 NEW HYDE PAKE RD. FRANKLIN SQUARE, NY Ii010 DRAI, NIND A-1 D~DROOM !z7 :~ D~DROOM D~DROOM _~ _~.2_~~. DDPROOM HALL .~Z..~!.~T SECOND FLOOR PLAN 5GALE. 114 =1-0 / t0'~9 tl2" 3 t/2" ..:)TOiZAQP I ~TORAQE' ATTIC HALL 2668 HAILL 2868 II ~TORAQE" 5TOP. AqE" ATFIC ATTIC.,. FLOOR PLAN SC, ALE, 114. =1-0 3~ REVISION~ _~OUTHPORT D~_51QN Izo N° OCE"AN AVE" DAYPORT, NY 11706 661-419-6158 DDDINC LD OPTONLIN E.NE'T PROJECT DESCRIPTION EXISTIN~ C, ONDITION5 AT 5TORY FRAME HOUSE AKA 655 PIKE RAILROAD AVE MATTITUC, K-,, NY' 11 ~t52 O~NER OLDE COLONIAL PLACE II0 NEW HYDE PAKE RD. FRANKLIN SQUARE, NY il010 DI~A!,NIN~ A-2 REVIOION0 EXIOTIN~ 3OUTHPORT D _31 N _3['RVIqE'3 12.O N° OCEAN AVE' DAYPORT, NY 11705 ~D~INC, @ OFrTONLIN ~,N ~T PROJEGT I)EOGRIPTION EXIOTING, 6ONDITION0 AT 5TORY FRAME HOUOE AKA 655 PIKE RAILROAD AVE MATTITUC,,K, NY' 1 lq52 O~NEE OLOE COLONIAL PLACE IIg NEW HYDE PAKE RD. FRANKLIN SQUARE, NY II010 13RA~IN~ PLUMBING ALL PLUMBING WASTE ~. WATER UNES NEED , TESTING'BEFORE cOVERING PLUMBER CERTIFICATION ON LEAD cONTENT BEFORE CERTIFICATE O£ OCCUPANCY i SOLDER USED IN WATER SUPPLY SYSTEM.CANNOT EXCEED 2/10 OF 1% LEAD. APPROVED AG NOTED NOTIFY BUILDING DEPAR'~ffENT AT 765-1802 8~TO4 PM FOR THE FOLLOWING iNSPECTIONS: 1 FOUNDATION - ~NO REQUIRED FOR POURED CONCRETE 2 ROUGH- FRAMING, PLUMEING, STRAPPING~ ELECTRICAL & CAULKING 3. tNSl~lOfl 4 FINAL-CONSTRUCTION&ELECTRICAL MUST BE COMPLErE FOR C O. ALL CONS~[.C'FION SHNJ. MEETTHE REQUIREMENTS OF THE COOES OF NEW YORK STATE. NOT RESFONSIBLE FOR DESIGN OR COMSTRUCTIOR ERRORS. ~- I ~:~COMPL f WiTH ALL CODES OF ~) NEW YORK STATE & TOWN CODES ~ AlS REQUIRED A~'~SONDIT[ONS OF S0UTHOLO TOWN ZBA SO,HOLD TOWN P~NNING ~OARD SOUYHOLD Tr)WN TRL]S~ EES ....... N.Y.S. DEC WP W THOUT CERTIFICATE OF OCCUPANCY ELE~CAL INSPECTION REQUIRED