HomeMy WebLinkAbout37401-Z ~~~Fpt,
f~ Town of Southold Annex 8/13/2013
a P.O. Box 1179
54375 Main Road
~ q~ Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 36441 Date: 8/13/2013
THIS CERTIFIES that the building DECK
Location of Property: 560 Kenneys Rd, Southold,
SCTM 473889 Sec/Block/Lot: 59.-3-35
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
7/13/2012 pursuant to which Building Permit No. 37401 dated 7/27/2012
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:
deck addition to existing one family dwelling as applied for.
The certificate is issued to Schultz, Thomas & Schultz, Karleen
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
- ` -
A fizzed ignat re
y~q* TOWN OF SOUTHOLD
BUILDING DEPARTMENT
~ ~ TOWN CLERK'S OFFICE
® SOUTHOLD,NY
*7 4~
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 37401 Date: 7/27/2012
Permission is hereby granted to:
Schultz, Thomas & Schultz, Karleen
PO BOX 2
Southold, NY 11971
To: construct a 20' X 32' deck addition to an existing single family dwelling as applied for
At premises located at:
560 Kenneys Rd, Southold
SCTM # 473889
Sec/Block/Lot # 59.-3-35
Pursuant to application dated 7/13/2012 and approved by the Building Inspector.
To expire on 1/26/2014.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $456.00
CO -ADDITION TO DWELLING $50.00
Total: $506.00
~
~
Building Inspector
a~-~
~~J~` l~~
Form No. 6 C~ a
TOWN OFSOUTHOLD. O L
BUILDING DEPARTMENT ? ~ 3~ r j
TOWN HELL
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 Here building or new use:
1. Final survey of property with aceurate'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 Fite Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 9110 of 1 % lead. .
5. Corrnmercial building, industrial building, mtittip[e residences aad similar buildings and installations, a certificate
of Code Compliance'ftom architect or engineer responsible €or fhe building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing bufldirrgs (prior to Aprf19, 1957) don-conforming uses, or buildings and 00pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features. ~ - _ -
2. A properly spmpleted 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 [o dwelling $50.00,
Swimmitig pool $50.00, Accessary building $50.00, Additions to accessory building $50.00, Businesses $50.00:
2. Certifteate of Occupancy on Pre-.existing Building - $100.00
3. Copy of Certificate ofOccupancy - $:25
4. Updated Certifcate o€ Occupancy - $50.00
5. Temporary Certificate ofOccupancy -Residential $15.00; Commercial $15.00
Hate. ~~3~/a
New Construction: D ~(°i1'( Old or Pre-existing Building: (check oneJ
Location of firopertY: O x'~J9/K/ ~U L ~
House No. Street Hamlet
Owner or Owners of ProP~Y= Tfi~07'/~ AS tl 9' A'J9k' Lrt ~7U /Y! S'G'NU ~ TL '
S'affolk County Tax Map No 1000, Section Jr ~ jock ~j Lot 3 ~
Sabd),vision Filed Map. Lot: '
Permit No. 3 ~ ~ Date of Permit APplitxtnC~N D7?1 A-S .S ~ I•/ u i7 Z
Heaidt Dept. Approval: Underwriters
Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ .~6.
~nnatu
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" 7 ~ o,~~,oe souryo .
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
1 NSPECTI
[ ]FOUNDATION 1ST [ ] RO H PLBG.
[ ]FOUNDATION 2ND [ ] ULATION
[ ]FRAMING /STRAPPING [ FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CON$YRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) ( ]ELECTRICAL (FINAL)
REMARKS:
d
DATE ~ ` INSPECTOR
y - 1
! ~~,OF 80llT,y_
f
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
NSPECTION
[ FOUNDATION 1ST [ ]ROUGH PLBG.
[ ] FO DATION 2ND [ ]INSULATION
[ RAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (~UGN) [ ] ELECTRIC,(1L (FINAL)
REMARKS: ~ T 6~ 7,~
-~J VAN /aa~i (~~.1-L1~s~Sn
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G~ ~ r ~
DATE ~ INSPECTOR
FIELD IlvBPECT>;ON REPORT DATE COMMENTS
W ro
FOUNDATION (1ST} ~ p
FOUNDATION (2ND) ,
x
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ROUGH FRAMING & ~
PLUMBING ~
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V'
INSULATION PEIt N. Y. H
STATE ENERGY CODE
3
FINAL
p ADDTTIbIVAL COMMENTS 7
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following, before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey ~
SoutholdTown.NorthFork.net PERMIT NO. 3~~0~ Check ?
Septic Form
N.Y.S. D. E.C.
Trustees
C.O. Application
Flood Permit
Examined, 20_ j Y Single & Separate
Storm-Water Assessment Form ?
Contact:
Approved ~ 9'7 ,20 fY Mail to: TNOmAS SGNU[.T~
Disapproved a/c PO /3QXa SOU7NOL/J
Phone: 1~3I GO? (~(o(oL
Expiration 1 ~ , 20~
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date , 20
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 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, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant or nom a corporation)
_p_~ ~ ~ so -r w 7
(Mailing address of applicant
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises T/;pYT^ qS AN/l7 /t A /Z.L t 711 J'1? S'GN U L ~ 2
(As on the tax roll or latest deed)
[f applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer) _ :
Builders License No. , i j ,
Plumbers License No. . ~I ~ U L 1 2 `Cu ~2 ~
Electricians License No.
Other Trade's License No.
BLDG. DEPT.
TOWN Of SODIHOLD
I . Location of land on which proposed work will be done:
ww RiJ. So~.'>.+~OL~J
House Number Street Hamlet
County Tax Map No. 1000 Section_S`'/ _Block ~ Lo 3J
Subdivision 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 AIIp~T7nx1 0~ IJ~G,t Ih/ .2~AQ 01= EL'/S'T/~??~ N6h"1 ~
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work D GiC A/JD/ ~7/~Yt/
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify 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 Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front ~ ~ Rear 33 ~ Depth a4
Height Number of Stories
9. Size of lot: Front / 0 y' Rear / ('J h ~ Depth 3 Sa
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated k fS0
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 Address Phone No.
Name of Architect Address Phone No
Name of Contractor 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
* 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 YO K)
SS:
COUNTY O C
~1a ~ ~LV1.tl~. `Z being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
r---
(S)He is the
(Contrac r, 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.
Sworn to before me this
! day of ~ 20
- L VICKI TOTH
Notary Public, Stat@ of New York
~1 No U1T06190696
Nota Public Qualified in Suffolk County Signature of Appl an
rY Commigsir~, -mica*. lu!v7R ?
e~~
' ~ Town of Southold -Chapter 236 - Stormwater Management
+~~g SWPPP -Storm Water Pollution Prevention Plan Assessment Form
GF.NF:RAT. INFORMATION: (All Requested Information is Required for a Complete Application)
APPUCAtrr NAME: Ownar•AgeM-CoruWbnt-Cgnbxbr ar Other lekcle Onef Properly OWNER pt Dilhnnt Man Applkanq
t..TZ
Admeaa:
a~ L ~N
Teiaphple t. Faa k TeNpMm R pp ~ -
E-MaR: E-Mae:
T p p
k ~~,(JYV s BrielDeaaipdon of Conatrtrclioa Ae&vity, ProPoxd StnrcDaal BMFf, Sod
a.C.T.M. t. t000 Stibalization BMP,, rpgea Scope and/or Segtrmce of Comtnution Acrtvity
o.. e.w., aTa to ~ /l rp wam. A?earo,rP/.~g..„RIe'e,.et
Nane gr Centraebrendlw COMaef Parsee RaepensMU rorfmptemeMagon otsvwPP: _('1L~~/~/~~~(1_pJJ_4i11~ -G(1'?-..Y~I~L.-Q1t
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TsNPhone Ak Fas P. ___/,yG _\[6c ~(f-~L.l.v_L1L_L~~)! L_~rrL^iC ~_)p~~f~y~
E-M,a: --TQ _~1.L~c__fK J`1W~_EJ-EL'!4r(O
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Nsme er Pegorro RntaMSlbh rx tnsWlegena IntenaMeor Erosion COntrd Pradke: -,~_~,~`~~_TL xu,-~~~~yt~~.
LL JJIS L'G / I
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Atlar.,a: _.nJI~I//~~E~-~~a_4~11L1..,,_yyI//~yyt_~tt.,,~_'_Fr_(yI~Y!2---p--'-'-- i , ,
Telephone g: Fax M: _/~crs..4/ljX~L~~__r~FK__TLlf.c 1r!'(Y~~-.~_C Uyi_1(~ i
E-Mail -.~~.L.-L.LC LCC..aLl.L..{./__.L_J1J_Ft _l-~7 T.~.~v~.~~/ll~~J
Tolat Areada - TotalArea of LaM CJeanng __LAf,(J)t!_r----------.----------~-j------
ProieclPartep: GN~O Sr arwor crouf,a Disnabarka: _..P/21I1'~.Q.7.~ L!l?/_~._JJ!!._.[..i
.4.L'------
t3.F.//wu) (S.f.lntml r^ ,AF 11,, 11 d p y n
Project Duration: Stan End /,Q.V//K~ ,~(J.y. fs r
tAngdpaled, s D,te: Date: y a, a so/~-com_ gas/z~a~>~__l.~ s,~e~r>~- - -
Will this Project Dlsturbe Me (5) or More Acres at ~ ~ -
AnyOneTimeDuringtheProposedDevelopment? Yes No
If YES: Phase Argwer gar Folbwingi
a. Does the Applicant have a Qualified Inspector On 0
Staff To Conduct the Required Inspectors ? Yes No
b. Does the SWPPP Indicate How Frequently the Site O ~ List the NAMES OI tlesaipiton al alt PolenlWlly Impacletl Waterhodks arMlor WagarMS:
Inspections will Occur and for What Period W Time ? Yes No
c. DcesNre 3WPPP Adequately ldentlfy Ap Tenpcxary
andlaPermanentSOilStabalizafionMeasures? YeO N -
d. Does the SWPPP Adequately Menfify a Complete - - - ;
Project Phasing Plan 7 Yes NOo stew, or knp waareeey: (re, rwoi, w>,aj Lune, krgalred...)
e. Does the SWPPP Indcate Additional Site Spedfic '
Practices Thal Will be Utilized to Protect Water Quality ? YeO NOo
f. Has the Applirant Submined a Completed DEC Notice - - - ~ ~ ~ _ - _ - ~ - - -
p N' (eg. Lake, Crs a
Of Intent and SW PPP Acceptance Form for Review ~ O type or xn .p .twoo eke rye Pontl. SouM, Fre~hwaterwetlantl~
by the Town of Stwlhold ? Yes No
Sl'A9'E OF NFW YORK, J
~~O~UyyN~1/'Y~O'F SS
?'hat I, :.`..ytJ..,
~L..{:1,(,r(.~...~ Z....,..... being duly srw/m, depoxs says that he/she is the applicant for Permit,
(Name M hdividu9l aTp~ dnn9a Doa,nerg ;
And that he/she is the ..............~................................................~2 ,
(owner. oortkaobi. ..OIMei: etc)
Owner and/or representative of the 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 appliation are true to the best of his knowledge and belief; and
that the work will be performed in the manner xt forth in the application filed herewith.
Swom [o before me this;
day of vl-Q 20.~.
Notary Public :..............~(....A~4~1.......~~.-.-.~. ..r.,V .a'ry'1~j ~ 'w '
(SignaNre d AppFCard)
SWPPP Assessment FORM: 03-12 NOtary Public Ste ~
No.OlY06190696 Y
Qualified in Suffolk Counri f
Commission Expires IuIV ?R o
SURVEY OF CERTIFIED T0: THOMAS H. SCHULTZ
KARLEEN M.SCHULTZ
DESCRIB D PROPERTY FIDELITY NATIONALTITLEINSURANCECO.
SITlI~ATE AT
SOUTHOLD JOB N0.2007-115
TOWN OF SOUTHOLD MAP N0.
SUFFOLK COUNTY, NEW YORK FILED: /~~p LANDSU9
S.C.T.M. DIST. 1000 SEC. 059 BLK 03 LOT 35 REVISONS:
LOC. FOUNDATION 4/20/07 / P,NDONq~n~L~<
FINAL SURVEY FOR C.O.'S 9/19/07
25 13 0 25 50 75 100 125 150 175 200 225 RELOCATE DRIVEWAY 10/19/07 e o ~
SCALE.• 1"= 50' DATE: FEBRUARY 23, 2007 REVISE CERTIFICATIONS TO NEW 0 E fir. ^ ,.u, ^
9!20/2009 ~
LOT AREA: 37,700SO.FT.=0.866 ACRE .:~rqT~~°.05036` P~
CLEARED AREA(LOCATED 9/19/2007): 23,389 SOFT. F Dp N E~
LICENSE NO. 050363
HANDS ON SURVEYING
26 SILVER BROOK DRIVE
FLANDERS, NEW YORK ~ f
11901
TEL: (631)-723-1954 - FAX•(631)-723-1329
MARTIN D. HAND L.S
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FEE ~BY~"~_ ~ s
PJOTIFY BUILDING DEPARTMENT AT ~ I , ! ' r
765-1802 8 AM TO 4 PM FOR THE ~y;~ E ~ ~ '
FOLLOWING INSPECTIONS: ~ ' ,
1. FOUNDATION -TWO REQUIRED ~ ~ ; ~ -
FOR POURED CONCRETE 1 ~
2. ROUGH -FRAMING, PLUMBING, ~ ~ ;
STRAPPING, ELECTRICAL 8 CAULKING j ~
3. INSULATION I
4. FINAL - CONSTRUCTION d ELECTRICAL 1
MUST BE COMPLETE FOR C.O. '
ALL CONSTRUCTION SHALL MEETTHE 2 ,1 . ,~~J r.ti ~~u/~r ~JE'?,~; !
REQUIREMENTS OF THE CODES OF NEW~j/
YORK STATE. NOT RESPONSIBLE FOR 6~k
DESIGN OR CONSTRUCTION ERRORS. ~ r ~
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