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HomeMy WebLinkAbout38179-Z f Town of Southold Annex 9/17/2013 ` P.O. Box 1179 54375 Main Road * Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36503 Date: 9/17/2013 THIS CERTIFIES that the building RESIDENTIAL ALTERATION Location of Property: 2175 Bay Shore Rd, Greenport, SCTM 473889 Sec/Block/Lot: 53.-4-14 Subdivision: Filed Map No. Lot No. conforms substantially to the Application far Building Permit heretofore filed in this officed dated 7/8/2013 pursuant to which Building Permit No. 38179 dated 7/18/2013 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 to an existine foundation as applied for. The certificate is issued to Rengifo, Robert & Collins, Sara (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED \ Aut ed 'gnahuw TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 'm ~,q SOUTHOLD, NY f d'f` 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 38179 Date: 7/18/2013 Permission is hereby granted to: Rengifo, Robert 8~ Collins, Sara 450 W 17th St _ _ New York, NY 10011 To: alterations to an existing foundation as applied for; flood pmt. included At premises located at: 2175 Bay Shore Rd, Greenport SCTM # 473889 Sec/BlocklLot # 53.-414 Pursuant to application dated 7/8/2013___ and approved by the Building Inspector. To expire on 1/17/2015. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 F1oodPermit $100.00 Total: $350.00 Building Inspector vn ~ ! 1~ ~ i r t Form No. 6 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 locatioh 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. Swom 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 (priorto 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 t. 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. 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 Date. ~ _ ~ 3 New Constmction: Old or Pre-existing Building: (check one) ~-Location of Property:~~15 ~1`t?IOYP C_ '~f~'PeY~p(~r~ House No. \ p Street ~ Hamlet X Owner or Owners of Property: _~be,f Trr Thy ~ ~-~p Suffolk County Tax Map No 1000, Section J J Block Lot Subdivision n Filed Map. Loi: Permit No. ~ C / ~ Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Cerfificate Final Certificate: (check one) Fee Submitted: $ SD , ~ l Applicant Signature *o,~,OF SMIT,yOf ~CWNI'1; TOWN OF SOUTNOLD BUILDING DEPT. 765.1802 INSPECTION [ FOUNDATION 1ST ( ]ROUGH PLBG. ( ]FOUNDATION 2ND [ ]INSULATION [ J FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [ ] EL AL (FINAL) REMARKS: ~1~~ DATE ~ ~ INSPECTOR _ _ - 2~- J ~ y~ ~o~~,OF SO!/rya6 «C G/ TOWN OF OUTNOLD BUILDING DEPT. 765.1802 NSPECTION [ ] UNDATION 1ST [ ]ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (RO H) [ ]ELECTRICAL L REMARKS: DATE INSPECTOR -r - 3 g r o~~,o~sna,~°6 TOWN OF SOUTNOLD BUILDING DEPT. 765-1802 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH LBG. [ ]FOUNDATION 2ND [ ] I CATION [ ]FRAMING /STRAPPING [ FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL) REMARKS: DATE _ INSPECTOR - ~ ~ TTS .o~M*~"""" A C C xav~,~ ~ ~ ~.~N.'Y. ~A1~'E ~'E~ CODS ~ ~ S ~p~IONkL CO~~ k o ~i (1n` V YYY 1 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BijILDING DEPARTMENT Do you have or need the following, before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans ~ e-S TEL: (631) 765-1802 Planning Board approv~ FAX: (631) 765-9502 Survey ~ SoutholdTown.NorthFork.net PERMIT NO. J~ $j 7 9 Check e-S Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined , 20~ Storm-Water Assessment Form _ , Contact: ~j -1, r ~7,~ S-~^~T Approved, 20~ Mail to: 4s2o U~ I ~l/!`/ Disapproved a/c ~ ~ ~~Z" . -NAi C" TA ~ vO ~ Phone: ~Q 'r'C - ('t Expiration ~ ~ 7 , 20~ I' n I~1~ f~ II `,'~l I','~ ~ , L~I I`' Building Inspector - 2013 ~ PLICATION FOR BUILDING PERMIT I,~ JUL 8 Date I Y ~ , 20 ~ 3 stoc oFPr. INSTRUCTIONS roe+'v or so~,~~n+aln 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. £ 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. /f~~~~//~~~ . (Signature of applicant or ame, if a corporation) ~ ~ N ~Maifng,~d~ ss of applicant) !JJ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~o~ert ~yt~ C s D wu-P~' I Name of owner of premises ~0~ P~/'y` V~~9 ~ 1 o GC.~ Sa'~K ~ inS (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. ~ ~ Z, Plumbers License No. Electricians License No. Other Trade's License No. 1. Loca~i land op which proposed wokk wil~be done: House Number Street Hamlet County Tax Iv);ap No. 10A0 Section~--~-~3-Block Lot Subdivision ~I''//~°,CV^i C, /SAy ~.S gT T~~ Filed Map No. (2 Lot 3~~- p~~ t 2. State existing use and occupancy of premises and intended use~ nd occ`u ancy of~proposed onstruction: a. Existing use and occupancy Si ti~P 'C~a~-~ (/J/~~~/ ~Q,,(~'{~t1~-, b. Intended use and occupancy ~ ~ ~4"''t < ~y t"' ""CS-~ ~9 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost ~ ~ ~ ~ ~ d ~ - ~ ~ Fee ~ 2 t7 © O (To be paid on filing this application) 5. If dwelling, number of dwelling units N Number of dwelling units on each floor /I7,¢ If garage, number of cars ~ A 6. [f business, commercial or mixed occupancy, specify nature and extent of each type of use. / V L 7. Dimensions of existin structures, if any: Front Z 6 Reaz ~ ~ ~ Depth 3 ( T-` Height Number of Stories 2 Dimensions of same structure with alterations or add' ions: Front 26 ~ Rear Z~ Depth 3 6 -Ff Height 2-~ ~ ~ Number of Stories 2 8. Dimensions of entire w construction: Front~~Rear Depth !G'r4 Height !t/~ Number of Stories N 9. Size of lot: Front 7(~ p~ Rear ~ Depth ~ ~ ~-7~~ - / ~ 10. Date of Purchase 277~I ~ Name ofFormer,,//O~~wner /~T ~ ~ ~ `~~~5 11. Zone or use district in which premises aze situated Y~ - Z w 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO x' 13. Will lot be re-graded? YES X NO Will excess fill be removed from premises? YES k NO 14. Names of Owner of premises ` Ty Address 2l 'i hone No. ~ i U Name of Architect Address Phone No Name of Contractor ~ ~ r, Sort Address Z ~ .Phone No. - Q -dO2' _ cu.~r~~oywe. Y 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES X 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 MAYBE 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) S: COUNTY OF ~O2n/`~ ~ n ~ ~ ~ being duly sworn, deposes and says [hat ~)he is the applicant (Name of individual signi g contract) above named, (~5)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 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 fore me this /i 3 r day of 7i~ 20 13 ~P11~6. Signature of Applicant ~n 6~irea Ja~"ery 1 20~ ryry~ . = 6;~ , ' ..c r~~„•„ It;~n. s3u~S Mall • , ~d~''H T. TERRY _ .ri. r.o. nl,c Ina TOWN CLERIC c~~. cP I SuulLold. Nc~~' Yurk 1 1 IIEG15FRM OF VITN. STnT751lCS 'I~l~~ 1- Fac IS IAI 7M15~1$~~ _ : ~ TdtRhunc I S 161 7GG`I n1ARnInGF OFFIC IZR ,JO~ RECORDS MANACEM ENi OFFICER FREEDOM OF INFORMA'iION OFFICER OFFICE OG T[-IE TOWN CLERIC TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent. regulations , of., the Code of the Town of Southold: "Floodplain Development Permit ~tpplica[ion" [FDP(93)), and r%Certificate of Compliance f1Sr Deve~pment in Special Flood Hazard Area [C/C(93)). / Bi:~~i. Gar ,•c.. TOV~';I OF SOt1~tOt.D / ~Jf~ ~~~h T.T. /Terr~,~yE~` Southold Town Clerk Cl August 25, 1993 ,I -1 ~ SEP 13 20b sio°, T~ I - ~ i i ' i ' ~ APPIICATIpN s - PAGE I of 4 TOWN OF SOUTHOLD PLOODPLAIN DG~'1JLOPMI;NT PCRMIT APPLICATION This Corm is to be ['filled out in duplicate. SECTION I: GENERAL, PROVISIONS (APPLIC to read and signl 1. No work may start until a permit k 'issued. 2 The permit may be revoked if nay fake stalemeots are made herein. 3. [C rcvokrd, a(( work must cease until permit is re-issued. 4. Develapme¢t shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire iC ho vrork k commcnecd within six months of issuance. 6. Applicant k hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Admhalstraloc or his/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND W ATTACHMENTS TO _ THIS APPLICATION ARE, TO TH~ B/~F$pT~~g/.~J Y (WO DGE, TRUE AND AC/~C ~(,jq/C'I'E. (APPLICANTS SIGNATURE)__1~"'~~ v DATE ' i i ~ / / /SECTION 2• PROPOSEb DEVELOPp,tENT !"f~-bc co~lctcd by APPLICM'il NAME ADDR S TELEP APPUCArrr 1~o vv`~' ,e~~-r`Jr-F~ f~~ Nom( ~(oo(~ ~~-Q'~t~~~{~!J BUILDER t ~ v Svti ENGINEER P ~ ~ Q ~ PROJECT' LOG4TION• To avoid delay io proo~ssing the application, plcaze provide cnou~ infor-malioo to easily identify the project location Provide Ure street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intvsecting road or wcu-known landmark A sketch attached to this appGcalion showing the project location woWd~be 6~pfy1 ~ ~d ~ _ e~ a~ -;1 r-- - - ~ ~ ~ ii FDP(93j a ~ SEP 1 3 2013 ~ r~ ~ `~u~ . • ~ • ~ APPLICATION PAGE 2 OF n DESCRIPTION OF WORK (Check all apphcablc boxes): A tTRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE O New Structure ~Resideotial (1-0 Family) ? Addition O Ruidcntial (Mort than 4 Family) ~heratioo ? Noo-residential (FloodprooCmg? U Yes) ? Relocation O Combined Usc (Residential & Commeraal) ? DemdGtioo' R ? Manufactured (Mobile) Hame (Ie Manu- ? Replacement factured Homc Park? O Yes) F,S["IMATED COST OF PROJECTS ~ 3~wvc w B. OTHER DEVELOPMENT ACTIVTI'IES: Fill O Mining ? Drilling Grading ? Excavation (Except for Struuural Development Cbccked Above) O Watercourse Alteration Qncluding Dredging and Channel Modifications) , O Drainage Improvements (Including Culvert Work) ? Roadi, Street or Bridge CoastrvUioo O Su/h'~~'vision (New or Ezpatasioo) _ I O ntlividual Walcr or Scwcr System / _ ~ G Other (Please Speufy) After complding SECTION 2, APPLICANT should submit form to Local Administrator for rcvicw- ' SECTION J- FLOODPLAfN DETERMINATION fTo be completed by LOCAL ADhf[MSTRATOF:) . The proposed dcvclopmcnt is located oo FDtM Panel No. Dated - The Proposed Development Is a(_IQ•[ located in a Special Flood Hazard Area (Notify the applicant that the appUcatioo • review is complete end NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ? [s located in a Specal Flood Hazard Arcs. FIRM zone d~cignation is 100-Year Rood elevation al the silt is:' ~ Fl. NGVD (MSL) ? Unavailable ? The proposed dcvclopmcnt is located io a Roodway. FHFM Panel No. Dated ? Scc Scuion 4 for additional Insinxiions SIGNED DATE ' 'r . APPLICATION # PAGE ] OF 4 SECTIOt` d ADDITIONAL fNFORMATION REQUIRED (To he comnlctcd 6v LOCAL ADMINIST RATORI The apphranl must submit the documents chcckcd below before the apphcaUOn can be processed: O A site plan showing the location of all existing structures, water bodies, adjaeeot roads, lot dimensions and proposed development. ? Devdopmcnt plans, drawn to salt, and specifiratipas, ioduding where applicable: details for anchoring structure, proposed elevation o(lowest (lour (ioduding basement), types of water resistant materials used below the lust floor, details of Boodproofmg of utilities located below We Cust floor and details of eodosures below the first Hoor. Also O Subdivision or other development plans (I[ the subdivision or other development exceeds 50 lots or 5 ages, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). Q Plags showing the extort of watercourse relocation and/or landlorm alterations. Q Top of new fill elevation Ft. NGVD (MSL). ? Floodproofmg protection level (von-residential only) Fl: NGV'D (MSL). For Qoodproo(ed strvc[uru, ;lppljcant must attach cerfdicalion from registered engineer or architect. ~ ? Certificaliov from a ~ pstercd engineer that the proposed activit~i in a «gulatory Iloodway will not result in a~ invcase in the height of fbc 100-year Bood. A copy of all data and calcula[ioru supporting [Ius finding must also be submitted. ? Other- SECTION Y PERMfT DETERMrNAT10N fTo be comolclcd by LOt;AL ADMINISTRATORI [ have dUermined that the proposed activity. A. O Iz H. O [s not in conformance with provisions of Local Law ~ , 19 .The permit is issued subject to the coodiliotu altacLed to and made part oC this permit. SIGNED ,DATE I( BQX A is chcckcd, the Local Administrator may issue a Development Permit upon payrnenl of designated (cc. If BOX B is chcckcd, the Local Adminiuralor w01 provide a wriueo summary of deficienciu. Applicant may revise and resubmit an application io the local Administrator or may request a bearing from lbe Board of Appeals. r . - APPLICATION a _ PAGE a OF a APPFAI,S: Appealed to board of Appeals? ?Ycs O No Hearing dale: PPc ncd~B Ycs 8 Pte Conditions SFt'ftnN h• AS•DUILT ELEVATIONS ffo be submitted by APPLICANT before Cer[ificatc of Comolianee • is ued The (oUowing information must be provided for project structures. This scc[ioo must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. • f. Actual (AS-Built) Elevation of the lop of the lowut floor, including basement ~ Coastal Hi¢h Hazard ea bottom of lowest strvuural member of the lowut Door, excluding piling and columns) is: FC. NGVD (MSL). 1 L - AUUaI (As-Buil[) Elevation of Doodproofmg proteuioo is FI'. NGVD (MSL). NOT~~: Any work performed prior to submiUal ~bf tLc about information is al the risk ,5( fLe App4:can 1. i r ~ SECTION 7~ COMPLIANCE ACTION fTo be comolctcd by LOCAL ADMfNISTRATORI The LOCAL ADMINISTRATOR will complete lhis section as applicable based oo inspcaioo o[ the project to ensure compliance with the commlmit}ts local law for Dood damage prcvention- INSPfiCTIONS: DATE BY DEFICIENCIES? OYES ONO DATE BY DEFICIENCIES? ? YES ? NO DATE BY DEFICIENCIES? ? YES ? NO SECTION 8• CERTIFICATE OF OMPLIAN E(To be comolctcd by LOCAL ADt.1INISTRATORI Ce~cate of Compliance issued: DATE BY: - • _ Attachment 8 , ~ BAMP,~E CERTI~~CATE ~F COMPLIANCE for Developmentin a Special Flood Hazard Area , ~,~r ~ .TOWN OF SOUTHOLD CCRTIFICATI; OF COMPLIANCIJ FOR DEVELOPMENT IN A SPECIAL FLOOD [-IA-ZAILD +1ALA -~^~W~It-MUST RETAIN THIS ('FRTIFICATE)__- PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ? NEW BUILDING ? EJCISTING BUILDING ? VACANT' LAND / ) ~ , ~ THC LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE 1S HEREBY CERTIFIED WITH THE REQUIREMENTS OF - LOCAL LAW 19_ SIGNED: DATED: B. CO"~IPLIANCE IS HEREBY CERTIFIED WITH TI;E REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: CIC(93) ~o~~pF SOplyolo Town Hall Annex Telephone (631) 765-1802 54375 Main Road ~ ~ Fax (631) 765-9502 P.O. Box 1179 Southold, NY 11971-0959 ~ ~1~~0UNT`I,~c~ BUILDING DEPARTMENT TOWN OF SOUTfIOLD August 27, 2013 Robert Rengifo & Sara Collins 450 W 17th Street, Apt• 1804 New York, New York 10011 To Whom It May Concern: RE: 2175 Bay Shore Road, Greenport Please complete sections 1 and 2 of the enclosed FEMA permit and return to our office. It is required when you are in a flood zone and is kept in your building permit file. After we receive it, I will be able to process your Certificate of Occupancy for Building Permit #38179. Please mail to: Southold Town Building Dept. PO Box 1179 Southold, New York 11971 Attn: Connie If you have any questions, please call me 765-1802. 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