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Home My WebLink About38013-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 5/28/2013 CERTIFICATE OF OCCUPANCY No: 36259 Date: 5/28/2013 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: ALTERATION 870 (aka 169) Horton Ave, Mattituck, Sec/Block/Lot: 141 .-2-21.7 Filed Map No. conforms substantially to the Application for Building Permit heretofore 1/1/1900 pursuant to which Building Permit No. 38013 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: "as built" non-habitable finished basement {for storage) in an existing one family dwelling as applied for. Lot No. filed in this officed dated dated 5/13/2013 The certificate is issued to Solomon, George & Solomon, Eileen (OWNER) of the aforesaid builffmg. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 38013 A/lt(h,~iz ed~gn at ulJe 6/14/10 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 #: 38013 Date: 5/1312013 Permission is hereby granted to: Solomon, Geor~[e & Solomon, Eileen 169 Horton Ave Mattituck, NY 11952 To: "as built" non-habitable finished basement (for storage) in an existing one family dwelling as applied for. Replaces 35679. At premises located at: 870 Horton Ave, Mattituck SCTM # 473889 Sec/Block/Lot # 141.-2-21.7 Pursuant to application dated To expireon 11/1212014. Fees: 1/1/1900 and approved by the Building Inspector. AS BUILT - SiNGLE FAMILY ADDITION/ALTERATION CO - ADDITION TO DWELLiNG Total: $150.00 $50.00 $200.00 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. ~B~YC9 Z Date JUNE 30, 2010 Permission is hereby granted to: GEORGE & EILEEN SOLOMON 169 HORTON AVE MATTITUCK,NY 11952 for : "AS BUILT" NON-HABITABLE FINISHED BASEMENT (FOR STOP, AGE) IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. at premises located at County Tax Map No. 473889 Section 141 pursuant to application dated JUNE Building Inspector to expire on DECEMBER 870 HORTON AVE MATTITUCK Block 0002 Lot No. 021.007 7, 2010 and approved by the 30, 2011. Fee $ 400.00 Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF CCCUPAN This application must be filled in by typewriter or ink and submitted to the Building Del 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 installation from Board 0fFire Underwriters. 4. Sworn statement from pluml~er certifying that tho ~oldor used in system contains leas than 2/10 of 1% lend.. 5. Commemiat building, industrial building, multiple rcsidenccz 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 phan 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 linc~, streets, building and unusual natural or topographic features. 2. A properly copmpleted application and cor~sent to inspect signed by the applicant. Ifa Certificate of Occupancy is denied, thc Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certifieaie of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimmir~g pool $50.00, Accessory building $50.00, Additions to accessory building $50:00, 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. Tem'p°raryCertificate°fOccupancy-Residential$15'O0'C°mmercial$15'00 ~/6~D'~/3Date. New Construction: Old or Pre-existing Building: . (cheek one) Flo~s~ No. Street Hamlet · Suffolk County Tax Map No 1000, Section Block Lot 8ubdivisi0n Filed Map. Lot: Pormit No. . . Date of Permit. Applicant:. Health D~t. Approval: Undetwritera Approval: Planning Board Approval: Request for: Temporary Certificat_e Fee Submitted: $ ~"0 .o~ ~ ~ ~ll"~ll% Final Certificate: (check one). Town Hall Ampex ,14373 Mare Road P.O. Box 117!) Southold, 575' 115171 Telephone (631) 763-1802 Fax (631) 763-9502 rofler, dchert(O, lown southol0.n¥.us B1 fILl)lNG I)I';PAI/TMENT TOWN OF $OUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: George Solomon &ddress: 169 Hodon Ave City: Mattituck St: NY Zip: 11952 ~uildingPermit#: '*~<~'~ Section: [1~ ~ Block: ~, Lot: ~_~l~'~ WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: License No: SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Sarvicelph ~ Heat ~ Duplec Recpt ~ Ceiling Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Main Panel A/C Condenser Single Recpt Recessed Fixtures Sub Panel A/C Blower Range Recpt Fluorescent Fixture Transformer Appliances Dryer Recpt Emergency Fixtures Disconnect Switches Twist Lock Exit Fixtures Other Equipment: replace 100a main panel. Repair water dammage HID Fixtures Smoke Detectors CO Detectors Pumps Time Clocks TVSS Notes: Inspector Signature: Date: June 14 2010 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING/STRAPPING [ ] FIREPLACE & CHIMNEY [ ] ROUG~,BG. [ ] IN~IJ~ATION [~INAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Disapproved a/c PERMIT NO. 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 Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: ~"~ ~ ~"' Expiration ,20 Building Inspector CATION FOR BUILDING PERMIT a. tis a~plete~v filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plan ~~~~rding to schedule. b. P ~~f lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and wate~vays. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon approval of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such a pemit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any pu¢ose what so ever until the Building Inspector issues a Ce~ificate of Occupancy. f. Eve~ building pe~it shall expire if the work authohzed has not commenced within 12 months after the dine of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the prope~y have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the pe~it for an addition six months. Thereafter, a new pe~it shall be required. ~PLICATION IS HEREBY M~E to the Building Depa~ment for the issuance of a Building Pe~it pursuant to the Building Zone Ordinance of the Town of Southold, Suffblk County, New York, and other applicable Laws, Ordin~ces 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 regul~ions, and to a&nit authorized inspectors on premises and in building for necessa~ inspections.~ ~ (Slgna~~ame, ifa co~oration) (Mailing address o[a~plic~t) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electhci~, plumber or builder Nameofownerofpremises ~- ! &)?/Cq~t,D (As 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 la;ad on which proposed work will,b~ done:__ House Number Street Hamlet County Tax Map No. 1000 Section Subdivision Block ~:~ Filed Map No. Lot 4/ 7 Lot 2. State existing use and occupancy of premises and intended use and,~,cupancy ofpropose~t construction: a. Existing use and occupancy ~4rof~t'~C~ ~=~ ,(~-e~kr4e, z,,_; b. Intended use and occupancy ~--~ rt~f,a,~ c'-~, 3. Nature of woff['check which applicable): New Building Addition Alteration Repair~ Removal Demolition Other Work Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear _Depth Dimensions of same structure with alterations or additions: Front Depth. Height Number or Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear _Depth 9. Size of lot: Front Rear .Depth 10. DateofPurchase '7////¢~ Name of Former Owner /~o~'e-t'C¢ /-J/~tv':// 11. Zone or use district in which premises are situated 12. Does proposed construction violate anY z°nkng law, ordinance or regulation? YES NO ./ _ 13. Will lot be re-graded? YES NO v Will excess fill be removed from premises? YES NO C"'/ 14. Names of Owner ofpremise~/~oK..qO_.,,'~d'e'r~,~//~ddress/[q~ ~,,Z/~'/~ ~. _Phone No.c~ NameofArchitect - O ' 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 * 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 o,~rvey. 18. Are there any covenants and restrictions with respect to this property? * YES NO · IF YES, PROVIDE A COPY. STATE OF NEW YORK) .d~ S: SS: (~_~'~ r~q ~--~' C~ ~,t~4 0¢-fl being duly sworn, deposes and says that (s)he is the applicant (Name of indiv(~al 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; that all statements contained in this application are tree 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 ~ . '/Sft~ davof "N,J-4 ~ 20 / 0 No}a[-y'Pubj~ta~ [7~'1(~, ~t~.te Of New York No. 02AR4711005 Qua fled In Suffolk County My Commission Exp res 02125/20 ..x - L/ Si~natt~re o'-f 'Applicant Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATIOH: S.e.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A IL! "O---W'TE O '"O,D...OE DENOS,ONCO NOL,-- Dlsblct Lot CERTIFIEID BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCIION ITEM# / WORKASSESSMENT I Yes No a. What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storm-Water Run-Off (Include Tofal Area of ail Parcels located within Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Proposed Construction) (This item will include all mn-off created by site b. What is the Total Ama of Land Clearing (S.F. / Acres) clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? impervious surfaces.} (s.F.~^~.l 2 Does the Site Plan andlor Survey Show AIl Proposed PROVIDE. BRIEF PROJF~T DESCR[PT][ON (m~d~ ~P.g... N.~.d) Drainage Structures Indicating Size & Location? This r"'l item shall include all Proposed Grade Changes and -- stoposco o,,,ng u scawaterF,ow. (~2'~/ ~/~ ~"J/~ '~" <'J' ~/~//~ / 3 D°es the Site Plan and/or Survey descflbe the er°si°n and sediment control practices that will be used to __ ~ (~,,~,~ j~ d~:)<:~ ~.. / /tt//O /L.~,./t/j controlsiteerosionandstormwatardischalges. This item must be maintained throughout the Entire Construction Pedod. 4 Will this Project Require any Land Filling, Grading or Excavation where there ~s a change to the Natural r~ Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? 6 ~s there a Natural Water Course Running through the Site? ~s this Project within the Trustaes judsdiction General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (1) or mom acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of ]and; which Exceed Fifteen (15) feet of Vedical Rise to including Construction activities involving soil disturbances of less than one (1) acre where One Hundred (100') of Horizontal Distance? the eEC has determined that a SPDES permit is required for storm water discharges. SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious for Storm Water Discharges rrm11 Construction activity. Permit No. GP-0-10-001,) Surfaces be Sloped to Direct Storm-Water Run-Off 1. The SWPPP shall be prepared prior to the submittal of the NOL The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the Department Ixior to the commencement of censtmction activity. 2. ~e SWPPP shet~ describe the erosion and sediment contr(~ practices and where 9 Will this Project Require the Placement of Material, required, post-consttuction storm water management practices that will pa used and/er Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants In storm water discharges and to assu~e Item Within the Tow/1 Right-of-Way or Road Shoulder compllamce with the terms and conditions of this permit. In addition, the SWPPP shall STATE OF NEW YORK, C COUNq~f OF ....~...~..Y.L~..~.(...~Z... .................. SS ThatI, G~/~ ~/~e"~L(~ //-~ beb dui sworn de ...........__.._..,.._..___.._..._..___.'ffi'.';,Z~;,Ji,;hl~h:;'~iT'7,;]'~$;~;~;) .................... g Y , poses and says that he/she is the applicant for Permit, And that hedsheis the I~ ,4./~ ~ ............................................ t'6~'~E ~U~'~;C~' ~;;.'~i ................................................................ 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; flint all statemenhs contained in this application are true to the best of his knowledge and belief; and that the work wiJl be performed in thc manner set forth iii the application fried herewith. Sw°rn t° bc[°re me thiS;Public: ~''~l, ~w~ 0~~~~ .................. "/'~" '~"'"""~ii~'""' day ~..¥/.....z?~... .................. 20../... Notary "'~'""~~1D'IM "A'RDAM' .... ..................... '~"r"'"'"~'222~'~2[~h~ur- ~;ata C~f Now York ;; .................. " ...... FORM - 06/10 No. 02AR4711005 Qualified In Suffolk County , My Commission Expires 02/28/20 [_~_' Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 · (631) 7 n:~ler, nchertg,~ (~ j)s~f~o~.n¥.u, BUll .DING DEPARTMENT TOWN OF $OUTHO/aD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: Address: Phone No,: Date: . ,,'Jo, 55/0' *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax Map Distn,'ct: JOBSITE INFORMATION: (*Indicates required information) zqF3 qF3'7 1000 Section: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) Block: Lot: (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Y~) NO Rough In ~ YES / NO Temp Information (If needed] *Service Size: 1 Phase *New Service: Re-connect Additional Information: 3Phase 100 150 200 300 350 400 Other Underground Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form Town Hall Annex 543?5 Main Road FrO. Box 1179 Southold, NY 11971 0959 Telephone (631 ) 765-1802 Fax (631) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTItOLD May 14, 2013 George Solomon 169 Horton Ave Mattituck, NY 11952 RE: 870 Horton Ave TO WHOM IT MAY CONCERN: The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy: JApplication for Certificate of Occupancy. (Enclosed) __ Electrical Underwriters Certificate. (contact your electrician) A fee of $50.00. __ Final Health Department Approval. __ Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) __ Trustees Certificate of Compliance. (Town Trustees # 765-1892) __ Final Planning Board Approval. (Planning # 765-1938) __ Final Fire Inspection from Fire Marshall. __ Final Landmark Preservation approval. __ Final inspection by Building Dept BUILDING PERMIT: 38013- "As Built" Finished Basement (storage) TOWN OWNER FORMER OWNER, OF SOUTHO~I~PROPERTY RECORD CARD VILLAGE .RES. 2~C3 LAND IMP. VL. Tu ~,AL REMARKS ! FAR~ Acre Tillable Tillable 2 Titl~bfe 3 Woodland Brushland Hofise Plot TYPE ~F BUILDING Mkt. Value ~ . /0~/~° oF ~'~a]~ L '/7~V FRONTAGE ~ ~ ~ FRONTAGE ON ROAD DEPTH ,.~f. O' BULKHEAD ', DOCK COLOR TRIM BJdg. ension ~sion '35: ~'7( '/'7 z ,tion (~ 8. Both ~asement Floors Interior Finish qeot 'ef'tsJon .ch eezeway rage ltio B. FLrePIoce Room ~)rivewoy Rooms Ist Floor ~,ooms 2nd Floor D!nette DR. 3R. F1N. B · . j Southold Town Building Department P.O. Box 1179 54375 Main Road Southold, New York 11971 (631) 765-1802 Parcel 1D: 141.-2-21.7 Permit #: 35679 Permit Date: 6/30/2010 Expiration Date: 12/30/2011 BUILDING PERMIT RENEWAL LETTER Dated: 10/25/2012 Applicant: GEORGE & EILEEN SOLOMON Location: 870 HORTON AVENUE MATTITUCK Work Description: AS BUILT ALTERATION "AS BUILT" NON-HABITABLE FINISHED BASEMENT (FOR STORAGE) IN AN EXISTING ONE FAMILY D~y~I~LLIN~IED FOR. ar A/~E OF $~ IS~RgQUi RED TO RENEWTHIS BelCDING PERMIT. Owner: GEORGE & EILEEN SOLOMON Address: 169 HORTON AVENUE MATTITUCK, NY 11952 The permit listed above has expired. Please contact our office as soon as possible to begin the renewal process. All work on the project must stop on the expiration date. No work is permitted or authorized beyond the expiration date. THANK YOU, SOUTHOLD TOWN BUILDING DEPT. Southold Town Building Department P.O. Box 1179 54375 Main Road Southold, New York 11971 (631) 765-1802 Parcel ID: 141.-2-21.7 Permit #: Permit Date: Expiration Date: 35679 6/30/20~ 0 12/30/2011 BUILDING PERMIT RENEWAL LETTER FINAL NOTICE Dated: 4/10/2013 Applicant: Location: Work Description: GEORGE & EZLEEN 5OLOMON 870 HORTON AVENUE MATTITUCK A5 BUZLT ALTERATION "AS BUTLT" NON-HA~T'TAI~LE FZNTSHEb BASEMENT (FOR STORAGE)TN AN EXISTING ONE FAMTLY bWELLTNG A5 APPLIED FOR. A FEE OF $150.00 I$ REQUIRED TO RENEW THI$ BUILDING PERMIT. OwRer: Address: GEORGE & ETLEEN SOLOMON 169 HORTON AVENUE MATTITUCK, NY 11952 The permit listed above has expired. Please contact our office as soon as possible to begin the renewal process. All work on the project must stop on the expiration date. THANK YOU, $OUTHOLb TOWN BUILblN6 bEPT. BUILDING PERMIT EXAMINER CHECKLIST Applicant: ~'~--0~C~ ~:~ -~ o L. o ~q aA/ SCTM# i000- /t/Z/ ~ c,9_ _ $hl, '7 Subdivision: Property Address: *Date Submitted: ..~-7-/ o Date Reviewed: ~ ~ [~- {o Owner: ~e-0£Co&-- ¢ ~-/L&-~-/t/ .~oL O/q OAt' Estimated Cost: Zone: ~- FO Conforming? City: /~~ Pre COs? BuildingPermits(Open/Expired):B?~-~el-Z/C/OZ-;~° g~Info: "t/z~ BP -Z/C/0Z- ,Info: BP__-Z / C/0 Z- , Info: BP __ Single & Separate Search Required? Y c~Determination: REQ. Lot Size: ~' ACT. Lot Size: REQ. Lot Coy. ACT: Lot Coy. REQ. Front ACT. Front REQ Side ACT. Side REQ. Rear PROP. Rear -- REQ. Height ACT. Height ··· ' ~ ,- Waterfront? Yo N~J? If yes, water body: ~ Panel~f ~ - Flood Zone: _~-~_B~khead/Blull~Dist~t~e, Suffolk County Health: Y or(~- If yes, *Bed#: *Date: / / *Permit#: Town Septic: Y or - If no, certification required: Y or N Received: Y or N By: NYS DEC: ~-n~c~a/Ts Y o(~- Date: / / Permit #: Southold Trustees: Y 0~Date: / Southold ZBA: Y og~)- Date: / / Southold Planning: Y o~ Date: / Town Landmark C of A: Y o~)TE: Permit #: Permit #: Permit #: / or NJ Letter- Notes: . or NJ Letter - Notes: - Notes: -Notes: *NYS CODE Compliance (page 2): Y or N Fee Structure: Calculation: Foundation: ~"~ SF 1.( First Floor: SF Second Floor: SF Other: SF 2. ( Total: SF SF)- ( SF)- ( SF)= SF X $ =$ + Initial Fee: + Additional Fee ( ): SF)= SF X $ --$ + Initial Fee: + Additional Fee ( ): TOTAL: $ tTt'O ~ , o6' NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC DESIGN CRITERIA: . Ground Snow Load: 2.0 . Weathering: Severe __..Frost Depth: 36" __ Design Temp: 11 · Ice Shield Underlay: YF_,8 USE/OCCUPANCY CLASS~'ICATION: · HEIGHT/FIRE AREA:., TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/PRESCR~TIVE HEADERS: Y/N WALL STUDs: Y/N CEILING JOISTS: YfN FLOOR JOISTS: YfN LUIV[BER SPECIES AND GRADE: Y/N Wind Speed: 120MPH__ Seismic Design Category." B . Termite: M-H Decay: S-M .. Flood Hazai'ds: GIILD ERS: YfN ROOF IC4A~ERS: WINDOw AND DOOR SCHEDULE: .MISSLE TEST REQUIREh{ENTS: EGRE~S 5.7 S.F.:~N , LIGH'I 8 % :j~)/N xq; T 4% HAILING/CONSTRUCTION SCHEDULE: Y/N MHANS OF EGRESS:~ PLUMBING RISER DIAGRAM: Y~ LOCATION OF F1-P~ PROTECTION EQU1PMEN;F:{~q TRuss DES N: CERT F C^T ON: Ok E~RGY CALCS ~ TOTAL COMPLIENCE~ (~TUI~ TO PAGE ONE) ~2009 IECC Energy Efficiency Certificate Ceiling I Roof 30.00 Wall 16.80 Floor / Foundation 16.80 Ductwork (unconditioned spaces): Window Door Heating System: Cooling System: Water Heater: Name: _ Date: CERTIFICATION OF BUILDING PERMIT REQUIREMENT (MUST BE SIGNED BY AUTHORIZED REPRESENTATIVE) This form MUST be completed and signed by an authorized person on behalf of the building authority in the City/County/Parish where the repairs to the damaged property are to be made--whether the permit is required or not. *If a Building Permit is required, a copy of the permit must be attached to this form. Seismic Study For construction of a new building, or an addition to an existing building, the building authority must indicate whether Seismic Safety Requirements are in place. Return documents to: U.S. Small Business Administration Processing and Disbursement Center 14925 Kingsport Road Fort Worth, Texas 76155-2243 If you have any questions, please contact your Case Iv~n~r at 800-366-6303. GEORGE SOLOMON ET AL Application Number: 0004294103 / Loan Number: DLH 3792626008 CERTIFICATION OF BUILDING PERMIT REQUIREMENT TO: Local Issuing Authority of Building Permits RE: Building P~mit Requirements For property of: GEORGE SOLOMON and EH.RRN SOLOMON Located at: 169 HORTON AVENUE, MATrITUCK, NY 1195? Please certify below the appropriate status regarding the Building Permit requirements for the above referenced property. __.A Building Permit is NOT REQUIRED for the repair/replacement consu'uction on the above mentioned residence. __A Building Permit is REQUIRED and a copy of said permit is attached hereto. Seismic Study Pursuant to Executive Order 12699 on Seismic Safety of Federal and Federally Assisted or Regulated New Business Construction, all new building construction that is assisted by the Federal Government must meet Seismic Safety Requirements specified in the National Earthquake Hazards Reduction Act of 1977. Please certify below regarding compliance with said requirements when loan funds are to be used for the cons~xuction of a completely new building or an addition to an existin~ buiJdln~, __All new building construction on the above mentioned property meets the "1988 National Earthquake Hazards Reduction Program Recommended Provisions for the Development of Seismic Regulations for New Construction." __Local building code does not include Seismic Safety Requirements. Date: Local Issuino Authority of Bnild~oo_ Permits Renre~ntative: Signature: '~a~ ~ Title: Phone: ARer completion please return to: U.S. SMALL BUSINESS ADMINISTRATION 14925 KINGSPORT ROAD, Fort Worth, TX 76155-2243 0[] COb!PLY W!TH ALL CODES OF ~- ~-IO ~ ALL CONSTRUCTION SHALL NEW YORK STATE & TOWN CODES l"~o~"~ ~ ~ .,. MEET THE REQU,REME '~ :., O- THF. AS REQUIRED ,~,.~uON .... ,_,N,_, ,.-,, I'--'-1 mis*. ~ ..... ~ I~y,.-T'~-.~,~:~,. i,~.~~- .,-. -'1...~ .... ~ ,_,,,P-'- ~ SEAL: / ~ 'r.~.,a~:,,.,~ - - . ,' ,~,. ~ ,--: ¢ _ ,; .r ~-~,-~ ~ .,~ ,/. "~¢- , :~ ~-~w / ~'-o"~. ~ ~,~ el~ ~ I ~ _~._ v ~_ " // ,,~, v ~t.,~ ~tD~ ~?1~ . L ~--~O {~ 7~1~ S ~ TO 4 ~ F~ THE ' I ~ [ -- ~ll.l~ ~OI~L FO~O~PECTI~S: ~ ~ ' [ ~ ~ ~ ,x~ 1. FOUN~TI~- ~ REQU ~ ~ ~ ( ~ " ......... FOR ~ED CONC~ ~ ~ I! FJ 2. r~H- ~, ~u~, ~ ~ ~ I ~ ~ JJ , ~ STiPPle, ELECTRIC~ & CAULKIN~ ~ . ' II 4. FINAL - CON~N & E~C~ICAL ,, ~~ ~l ....,....~s ~ ~ c~. o..~w -'--- {r-- ' "~ I' [ ~ i~lu __~ il~' ~ t~ o" A- r~