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Home My WebLink About37133-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 2/8/2013 CERTIFICATE OF OCCUPANCY No: 36136 Date: 2/8/2013 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: PORCH 14005 ROUTE 25 MATTITUCK, Sec/Block/Lot: 140.-3-28 Filed Map No. Lot No. conforms substantially to thc Application for Building Permit heretofore filed in this officed dated 4/4/2012 pursuant to which Building Permit No. 37133 dated 4/11/2012 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: Porch Addition to an existing Single Family Dwelling as applied for The certificate is issued to DAVID & PATRICIA DERIDDER (OWNER) of the aforesaid building. ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ~gnat~/re TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONR UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 37133 Permission is hereby granted to: DAVID & PATRICIA DERIDDER Date: 4/11/2012 P.O. BOX 1465 MATTITUCK, NY 11952 To: construct a porch addition to an existing single family dwelling as applied for At premises located at: 14005 ROUTE 25 MATTITUCK SCTM # 473889 Sec/Block/Lot # 140.-3-28 Pursuant to application dated To expire on 10/10/2013. Fees: 4/4/2012 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION CO - ADDITION TO DWELLING Total: $288.80 $50.00 $338.80 Building Inspector Form 1'4o. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by type~vriter 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 Uuderwriters. 4. Sworn statement froln plumber certifying that the solder used iu system coutains less than 2/10 of 1% lead. 5. Commercial buildiug, iudustrial building, multiple residences and similar buildings and installations, a certificate of Code Compliauce fi'om architect or engineer responsible for the buildiug. 6. Submit Plamfiug 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 liues, streets, building and uuusual natural or topographic features. 2. A properly completed application aud consent to iuspect signed by the applicant. Ifa Certificate of Occupancy is denied, the Building Inspector shall state tile reasons therefor in writing to tile applicant. C. Fees 1. Certificate of Occupancy New dwelling $50.00, Additions to dwelling $50.00, Alteratious to dwelling $50.00, Swimmiug pool $50.00, Accessory building $50.00, Additious to accessory buildiug $50.00, Businesses $50.00 2. Certificate of Occupancy oil Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated Ce~'tificate of Occupancy $50.00 5. Temporary Certificate of Occupancy -Residentia[ $15.00, Commercial $15.00 Date. Location of Property: / L-/r ~L9,-~ ~']~--~ House No. Owner or Owners of Property: /~,L} ~//J.~ Street Suffolk County Tax Map No 1000, Section ] q/O Block Hamlet SulSdivision Permit No.~-}~ / 3"~ Health Dept. Approval: Filed Map. Date of Permit. t.{ _ 1,2 - ~ ~k. Applicant: Underwriters Approval: Lot: Plmming Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Applicant ~gnature TOWN SOUTHOLD BUILDING DEPT. 765-1802 NSPECTION INDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT ~)I4SI'~U~I'ION [ ] ELECTRICAL (ROUGH) REMARKS: ] ROUGH PLBG. ]INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION ] ELECTRICAL (FINAL) DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ]/~JNDATION 2ND [ ~ FRAMING / STRAPPING ROUGH PLBG. INSULATION FINAL FIRE SAFETY INSPECTION [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ~.~~ 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-t 802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION [ ] ELECTRICAL (ROUGH) [ REMARKS: [ ] ROUGH PLBG. [ ] IN..:,~ULATION [ ~"~1NAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION ] ELECTRICAL (FINAL) DATE ~ INSPECTOR - STA~ E~ CODE .. T / ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN' HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork. net Examined Approved Disapproved a/c Expiration ,2o PERMIT NO. _-'~7 [ ?L~'2) /~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 C.O. Application Flood Permit Single & Separate Storm-Water Assessment Form Contact: Mail to: ~IVI I> D~.~I ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date (94. [o4 / 17_,.- ,20 a. This application MUST be completely filled itl by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee accordiug 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 applicatiou ~nay not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to tile 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 issuauce or has not been completed within 18 months from such date. If no zofiiag amendments or other regulations affecting the property have been enacted in the iuteri~n, the Building Inspector may attthorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to tile Building Department for the issnance 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, aud regulations, and to admit authorized inspectors on premises and itl building for necessary inspections. (Signature of applicant or name, ifa corporation) (Mailing address of applicant) State whether applicant i~owner,fl~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises D4(.JII9 I~ P~'~IC[¢O' 0~J~'O~'~'~ (,~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 Trade's License No. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section [ 40 Block O.~ Lot Z,~ Subdivision Filed Map No. Lot 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 Estimated Cost Fee If dwelling, number of dwelling units If garage, number of oars Addition Alteration OtherWork P£ma tva~,c M_ ~. ~Ol(. F)(Descripti°n (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specif2/nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear .Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Rear Dimensions of entire new construction: Front Height Number of Stories Size of lot: Front Rear Rear _Depth Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ~-- 4-o 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO / 13. Will lot be re-graded? YES NO ~qVill excess fill be removed from premises? YES NO__ 14. Names of Owner of premises ~)E-~ tOt;2~t'?-- Address Name ofArchitect/I~fftr-- _q-~/-/ud,4-~ f'~- Address Name of Contractor Address Phone No. ~2~'~" Phone No ~4 Phone No. 15 a. Is this property within 100 feet of a tidal wetlaad or a freshwater wetland? *YES * 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. NO 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 NO ~_ · IF YES, PROVIDE A COPY. STATE OF N,E,W YORK) k \ ss: COUNTY O ~l(4---' '~ k//'d k~---JffM 4~ ~ 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; tbat all statements contained in this application are tree to the best of bis knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this,--, ' Notdry Public i ' ~ , ~,' / ~ '-/ ~ ~ . / l~, F ~. r~o~ OCCU?ANC¥ OR IJ~;,.: k, UNLAWFLiL EXISTING ¢02 8 AM TO 4 PM FOR THE 'W!NG IN3PECTIONS: :',]:JNDATiON - TWO R~QUIRED FOR POURED CONCRETE STRAPP,NO ELECTRICAL& CAULKING 3 INSU~TION 4 FINAL- CONSTRUCTION & ELECTRICAC , 2X6 ACQ ~E~ MUST BE COMPLETE FOR C O ~ ~ ALL CONSTRUCTION SHALL MEE~ THE REOUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR ~ ~ : DESIGN OR CONSTRUCTION ERRORS. 6X6 PO~ ABOVE ~ 12"dia. CONC. PIE~ ~ ............. , ............................ 25'-1" . ~ NORTH ~; ~%~ KEVi~IONS: REVISIONS: WIND LOAD PATH CONNECTION AN_D CONSTRUCTION DETAIL DRAWINGS