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HomeMy WebLinkAbout38087-Z f Town of Southold Annex 4/30/2014 P.O.Box 1179 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 36885 Date: 4/30/2014 THIS CERTIFIES that the building SHED Location of Property: 995 Jackson Landing, Mattituck, SCTM#: 473889 Sec/Block/Lot: 113.-5-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 5/20/2013 pursuant to which Building Permit No. 38087 dated 6/11/2013 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: ACCESSORY SHED AS APPLIED FOR The certificate is issued to Mouzykine, Leonid&Mouzykine,Larissa (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED t>Azed Signatifre 0 � TOWN OF SOUTHOLD BUILDING DEPARTMENT r TOWN CLERK'S OFFICE fJ t • b 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#: 38087 Date: 6/11/2013 Permission is hereby granted to: Mouzykine, Leonid & Mouzykine, Larissa 18875 Route 25 PO BOX 233 Mattituck, NY 11952 To: Construction of a 12 x 20 shed in the required rear yard as applied for. At premises located at: 995 Jacksons Landing, Mattituck SCTM # 473889 Sec/Block/Lot# 111-5-7 Pursuant to application dated 5/20/2013 and approved by the Building Inspector. To expire on 12/11/2014. Fees: ACCESSORY $196.00 CO -ACCESSORY BUILDING $50.00 Total: $246.00 Building Inspector • Farm No.6 TOWN OF SOUTHOLD. BUILDING DEPARTMENT TOWN HALL 765-1$02 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following AX 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 Underwriters. 4. 'Sworn statement from plumber certifying that the solder used in system contains less than 2110 of I%lead. . 5. Commercial building,industrial building;,multiple residences and similar buildings and installations,a certificate of Code,Cornpliahce-from architect or engineer responsible for the building. 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: 1_ Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2_ A properly epmpleted 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 $150.00, 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$15.00 New Construction: Old or Pte-existing Building: (check one) - Location of F'roperty.'---1 oh rL � House No- Street Hamlet Owner or Owners of Property Suffolk County Tax Map No 1000,Section Block Lot Subdivision Filed Map. Lot: Permit No. i 7 Date of Pertrtit. C I l 7, Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: tequest for: Temporary Certificate Final Certificate: (check one) :ee Submitted: � Applicant Signature © OF SO(/T�o • A$_1 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUG PLUMBING [ ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR FIELD ON RELORT DATE CONIldms W d FOUND,piTT0N(1ST) cs FOUNDATION(2ND) ROUGH FRAAnNQ& PLUAMING U INSULATION PER N.Y. H STATE ENERGY CODE b vr �-O D FINAL ADDITIONAL COMMNTS tf 8 C O m Qm O e r ` 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. 5(f og Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined (/ 120 Single& Separate Storm-Water Assessment Form / Contact: Approved C� '20 Mail to: Disapproved a/c Phone: — -� Expiration 20 7� Building I Spector � r4 I LIGATION FOR BUILDING PERMIT i MAY 202013 Date �.� 3 , 20 INSTRUCTIONS BLDG DEPT. . T n.�N V ,V comp etely 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 4ame, if a corporation) (Mailing address of a plicant) �Y // State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ZE0A.1 C✓b 147C e2% C.� (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. 1. Location of land on which o®se d work vill by done: House Number Street -� Hamlet County Tax Map No. 1000 Section Block —J Lot ®/ Subdivision Filed Map No. Lot - 1 n .` 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. tended use and occupancy 3. re of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (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 Depth: Height Number of Stories 9. Size of lot: Front Rear Depth 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 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 As this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * F 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 YORK) SS: COUNTY OF ) being duly sworn, deposes and says that he is the applicant (Name of individual signing contract)above named, CONNI�D.BUNCH Notary Public,State of New fork No.01 BU6185050 (S)He is the Qualified in Suffolk County (Contractor, Agent, Corporate Officer, etc.) ommission Enpirepril 14, 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 4�n 4� day of \A 20 ell I h 2 � Notary Public Signature of Appl' ant Y Town of Southold - Chapter 236 - Stormwater Management �! �z SWPPP - Storm Water Pollution Prevention Plan Assessment Form GENERAL INFORMATION: (All Requested Information is Required for a Complete Application) APPUCANT NAME: Owner-Agent_Consultant-Contractor or Other(Circle one) Property OWNER:Pv Different than Applicant) AE IV 19 If CW Address: Address: I Telephones '! Fax N. Telephone t. Fax#: i E-Maw: 7 E-Maul: Property Address: Brief Description of Construction Activity,Proposed Structural BMPs,Soil S.0 T.M.N: 000 Staba6mtion BMPs,Project Scope and/or Sequence of Constru i lion Activity Dtetrfel Section abet LAt (Provide AdCG¢nel Fa as NeeueO I (1� ) Name of Contractor andfor Contact Person Responsible for Implementation of SWPPP: .------.---.----_._...._.,._....---_...--......._...-----^----_,-._-__ i - 1. Address: ________—__._..._-._..__..._--_-:__-:-_______________ i Telephone#. Fax ---------------------------------------------- E-New. -------------------------------------------- ; -------------------------------------------- �. Name of Persons Responsible for Installation 8 Maintenance of Erosion Control Practice: IIf Address: -------------------------____ I t 1 Telephone#; Fax#-. --------------------- i E-Mail: ------------------------------ i Total Area of All Total Area of Land Clearing Project Parcels: and)or Ground Disturbance: ---------------------------------------.---------- (SF./Amps) (5 F./A—) Project Duration: Start End (Anticipated) Date: Dale: (VA-Mr d c.Ie„d.,oey,) - -Will this Project Disturbe five(5)or More Acres at Q Q Any One Time During the Proposed Development? Yes . No ------------•--_---------_.------------------- - 6 If YES:Please Answer theFoliowingl -••,-._-.-------._-..--..-------------------------------- a. Does the Applicant have a Qualified inspector On Q Staff To Conduct the Required inspections? Yes No If b. Does the SWPPP Indicate How Frequently the Site 0 List the NAMES or d¢srxiption of all Potentially Impacted Waterbodies andlorwetlands: Inspections will Occur and for What Period of Time? Yes No c. Does the SWPPP Adequately Identity All Temporary Q Q and/or Permanent Soil Stabalizallon Measures? Yes - No d. Does the SWPPP AdequatelyidentifyaComplete. Project Phasing Plan? Yes No Status of Impacted Waterbody:(eq.TMDL,303(d)Listed,Impaired-) e. Does the SWPPP Indicate Additional Site Specific = Q Practices that Will be Utilized to Protect Water Quality? Yes No f. Has the Applicant Submitted a Completed DEC Notice Type of Impacted Waterbod .(eg.Lake,Creek, ' Of Intent and SWPPP Acceptance Form for Review [� 0 Y Bey,Pond,Sound,Freshwater Wetland...) by the Town of Southold? Yes No STATE OF NF.W YORK, Notary Public,State of ew York . COUNTY OF...........................................SS No.01 BU6185050 Quaffied in Suffolk County,,,,������Qj 1 hat I.................................................................................being duly sworn,deposeP?f %0W�&Pr#pJle�far YerTnit, (Name of individual aipning DocumeN) Andthat he/she is the .................. ..................... .................................. . ..........- (Uiwner Gbntiacto l+yeiuf,Cerpwate OtBce eii"j Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have perfor=d the said work and to make and file this application;that all sWeinents 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 herewith. I Sworn to before�me this; I ......... .:C9�....-......_day of....: _.. '20.13. I / �YE,Notary Public: � .�"`!� .....L.... !\ L �- b- -i .�'� ... (Signature of Applicant) I I SWPPP Assessment FORM: 03-12 V LOT 17 LOT 23 N 88' 34' 40' E f 192.0' caw An 91 a � --- 90.2' ooAC RAN do Y OMMMANC STOOw Co ' � t n* LOT 18 90.2 a nr 7.0. smw 7 6 a a G 0C �', WA14s ASPHALT DRIVEWAY How OEdt UN ER V W1 RAUW • o LOT 19 S 88* 34' 40' W 225.0 LOT 20 LOT 21 a Y TO*'Ae"W M s Wr IS PREPAAM AAV aN ANS BE7�AGt'70 7NE ME MWANY. GOWMAgNTAL AQEIV Y. L7V VEE SM=Gf 7w Los" niwm GUARAMM AN NOT I AAMMRAW 10 FM 5280 AmmNAL Mts"wr4 S OR s rAnvr� T MARCH 28, 07 1969 UMWYNM EA'AL MRA MW OR A=nCW fi Va TM lODO-1�3-05--D� ARWY IS A WMAMV W� Lip' GUARANTEED TO THE NEW YORK STAIr MXATM Lai. CG*X$OF TM SURVEY AW NOT bE'ARM►c t -20.0 ' LEONID MOUZYKINA M GANG SURWWWS E WWS$ED SEAL SHAU, A=31 LARISSA MOUZWINA NOT W C OMM OM IV Sr A VALID TRUE U. S DEPT. OF AGRICULTURE Oowy. FIRST AAlERICAN T/TLE INS. CO. JACKSON'S LgpQtNG"` COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED APPROVED AS NOTED �; L FEE:-�� NOTIFY BUILDING DEPARTMENT AT .g 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING OCCUPANCY OR 3. INSULATION 4. FINAL - CONSTRUCTION MUST USE IS -UNLAWFUL BE COMPLETE FOR SHALL CERTIFICATE ALL CONSTRUCTION SHALL MEET 7HE REQUIREMENTS OF THE CODES OF NEW OF OCCUPANCY U i�� � YORK STATE, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. _ x X, FRONT f-Lf-VATION l 1 1 T t t � j BACK ELEVATION SCALE., I,—On a � FRI sY E12 RIGHT SIDE SCALE. � = I'-O" i i