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Town of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 6/23/2012 CERTIFICATE OF OCCUPANCY No: 35773 Date: 6/23/2012 THIS CERTIFIES that the building OTHER Location of Property: 12700 Sound Ave, Mattituck, SCTM #: 473889 Sec/Block/Lot: 141.-4-26 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore 5/4/2012 pursuant to which Building Permit No. Lot No. filed in this officed dated 37214 dated 5/14/2012 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: "In kind" repair of an existing Handicap Ramp as applied for. The certificate is issued to Mattimck Presbyterian Ch (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 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 SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 37214 Permission is hereby granted to: Mattituck Presbyterian Ch PO BOX 1411 Date: 5/1412012 Mattituck, NY 11952 mo~ "In kind" repair of an existing Handicap Ramp as applied for At premises located at: 12700 Sound Ave, Mattituck SCTM # 473889 Sec/Block/Lot # 141.-4-26 Pursuant to application dated To expire on 11/13/2013. Fees: 5/4/2012 and approved by the Building Inspector. NEW COMMERCIAL, ALTERATION OR ADDITIONS CO - COMMERCIAL Total: $250.00 $50.00 $300.00 Building Inspector Form No. 6 TO~/N OF SOUTItOLD. BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF occUP,sd~ICy This' application must be filled in by typewriter or ink and submitted to the Building Department with the folloy~ing: 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 featur6s. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical inatallation from Board of Fire Underwriters. 4. Sw. orn statement from plumber certifying that the solder used in system con~ius less than 2/10 of 1% lead.. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code ComPliant'from architect or engineer responsible for the buildiag= .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 naturai or topographic features. - - 2. A properly c~mpleted 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. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00: Ce/tificate 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. ~ _ c{ _ t ~.- lqew Construction: Location of Property: Old or Pre-existing Building: House No. Owner or Owners of Property: . .C.L Suffolk Co~lnty Tax Map No 1000, Section i L~'I Subdivision (check one) Street Block t~ Lot Filed Map. Lot: Pesmit No. ~ 7d / c/ Health Dept. Approval: Planning Board Approval: Hamlet DateofPermit. ~% l q '~ I -/j Applicant:. Undemrriters Approval: Request for: Temporary Certificate Fee Submitted: $ C~) - ~/r~)'~c.~ ! . Final Certificate: (check one) ~ '~pplicant Signature TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]IN~SU~ATION [ ] FRAMING/STRAPPING [~.~NAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: 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 (t[A~ , 20 [~3 PERMIT NO. - 4 2012 BLDG, DEPI. I'OWN OF SOUIHOtD / B~i~i~g Inspector BUILD1NG 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: Robert Stromski AIA Mail to: P.O. Box 1254 Jamesport, NY 11947 Phone: 631-779-2832- APPLICATION FOR BUILDING PERMIT Date May 3 .20 12 INSTRUCTIONS 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 promises 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 1S HEREBY MADE to the Building Department for the issuance ora 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 necessary inspections. (Signature of applicant or name, ifa corporation) P.O. Box 1254 damesport, NY 11947 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder STROMSKI architecture, p.c. -Architect Name of owner of premises Mattituck Presbyterian Church (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer Robert Stromski AIA, LEED AP - President (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 which proposed work will be done: 12700 Old Sound Avenue Mattituck House Number Street County Tax Map No. 1000 Section 141 Subdivision Hamlet Block 04 Lot 26 Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Community Theater b. Intended use and occupancy Community Theater Nature of work (check which applicable): New Building Repair [-~ Removal ~ Demolition ~ 4. Estimated Cost 5. If dwelling, number of dwelling units N/A If garage, number of cars Fee Addition [~ Alteration [~ Other Work Re-construct Existin.q Ramp (Description) (To be paid on filing this application) Number of dwelling units on each floor N/A 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Theater - Assembly 7. Dimensions of existing structures, if any: Front49.6 Height Number of Stories 2 Rear 48.2 Depth 81 Dimensions of same structure with alterations or additions: Front 49.6 Depth 81 Height Number of Stories 2 Rear 48.2 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front50 Rear54 Depth 130 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 X 13. Will lot be re-graded? YES [] NO[~ Will excess fill be removed from premises? YES [] $Ol~_ 14. Names of Owner of premises aattituck Presbyterian Churc~ Address~Phone No. Name of Architect STROMSKI architecture, p.e. Address PO Box 1254 Jamesport, NY 11947 Phone No 631-779-2832 Name of Contractor STROMSKI architecture, p.e. Address m Box ~254 a..~p~, .¥ 11947 Phone No. 631-779-2832 15 a. Is this property within 100 fcct of a tidal wetland or a freshwater wetland? *YESJ~_NO [] * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora 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~_ NO [] · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) STROMSKI architecture, p.e. (Robert Stromski) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the Architect and agent (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. Swom to before,~me this _ ~ ~ /~ 4//4` /~ayJof /V/~ ~q/(/ 20//~_ // I' / /5/ , . .EEST.O 5 I / / ~ - ~OT^a¥ P. ~N~otary/Pul~c ~tl ~ F,E~0 :%IF; O U, ~O~I~Y~ _ Signature ~:DJplicant ~/~ -- '~ERM ExPIRES D~[B~R 31 ~0 ~/ SITUATE Replacement of Existing ~ MATTITUCK ADA Ramp For: i -i~'~L.,,,~"~ .-~'.: TOWN OF SOUTHOLO North Fork SUFFOLK COUNTY, NEW YORK O~t'~ ~' !~;~" ~ SCALE '':~0' "1 'heater ~D' ~S S.C. TAX No. 1000-141-04-26 Comm~ity 0.155 ac. 12700 Old Sold Avenue p~S~~ TITLE ~~-, SITE PLAN SHEET SP-1 Q DEMO PLAN GENERAL NOTES: MATERIAL NOTE5 RAMP/ PLATFORM CONSTRUCTION FGUNDATION CONSTRUCTION I:$IGN LOAD5 CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA NIND 5PI~D B SEVEP~ DE~AY N/A L--J Q P-,AMP SECTION (3): CPeOWOe v'~' m ~OLT) PI~OV~DE GrRD~R TO POST O:X~ECTOR5 AT TOP O~ ~05T. TYPICAL ALL 3 1/4" ~PIER AND FRAMING PLAN U ~ P. AMP FI FVATION EETAIfl IFIr~RM WATER RUNOFF PURSUANT T2 CHAPT~ 236 OF THE TOWN CODE APPROVED ;.S NC'ED 765-t802 8 AM TO 4 P; tOR THE FOLLOWING INSPEC TI~',~S 1 FOUNDATION- TWO ~FOUIRED FOR POURED CONCRL~ E Z ROUGN- FRAMING PLUM6,N3 STRAPPING. ELECTRICAL & CAULKING 3 INSU~TION 4 FINAL - CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FOR C O ALL CONSTR~TION SHALL MEET THE REQUI~MENTS OF THE CODES OF NEW YORK STATE ~T RESPONSIBLE FOR DESIGN ~ C~TR~TION E~ORS OCCUPANCY OR USE IS UNLAWFUL ',~'~<;: tT CERTIFICATE u,,: OCCiJPANCY u~o~s'ru~l~D .~L ("Pn~CAL ALL) Replacement of Existing ADA Ramp For: INorth Fork ~Community ITheater 940 Oak Drive Southold, New York S.C.T.M.# I000-80-2-8 REVISIONS IQ lC). I0_ IQ I©. IQ IQ SEAL TITLE RAMP DRAWINGS AND NOTES SHEET A-1