HomeMy WebLinkAbout38985-Z fir,°:ZZ�{t
�� y�►FFQI �w� Town of Southold Annex 7/15/2014
P.O.Box 1179
54375 Main Road
� ' • Southold, New York 11971
f•.
CERTIFICATE OF OCCUPANCY
No: 37023 Date: 7/15/2014
THIS CERTIFIES that the building RAMP
Location of Property: 2825 Kerwin Blvd, Greenport,
SCTM#: 473889 Sec/Block/Lot: 53.4-44.32
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
6/24/2014 pursuant to which Building Permit No. 38985 dated 6/24/2014
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:
HANDICAP RAMP TO A SINGLE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Bondarchuk,Marie
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
A ed ignature
TOWN OF SOUTHOLD
w
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#: 38985 Date: 6/24/2014
Permission is hereby granted to:
Bondarchuk, Marie
2825 Kerwin Blvd
Greenport, NY 11944
To: handicap ramp as applied for.
At premises located at:
2825 Kerwin Blvd, Greenport
SCTM # 473889
Sec/Block/Lot# 53.-4-44.32
Pursuant to application dated 6/24/2014 and approved by the Building Inspector.
To expire on 6/24/2015.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00
CO -ADDITION TO DWELLING $50.00
tal: $250.00
'uildi g
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 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 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(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 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
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.
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. 2LO2Q
New Construction: Old or Pre-existing Building: (check one)
Location of Property: kC/z Gill A) FLVV
House No. Street Hamlet
Owner or Owners of Property: _M)'A t & OA ):2 12C f-(iack
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision p Filed Map. Lot:
Permit No. 0 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: `� (check one)
Fee Submitted: $ fa) '03 C)Mn&
�
014
scant Signature
�_ �o��pF SOUTyO�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROU LUMBING
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ]
FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ) ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
AA �EL��
DATE INSPECTOR ZL
FIELD IXSPE ON RI ORT DATZ COIVMNT3
p0
FOUNDATION(1ST)
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FOUNDATION(2ND) 5
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ROUGH FRAA31G& y
PLUMBING
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INSULATION PEA N.Y.
STATE ENERGY CODE
rx, 61
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FINAL
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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
Southold Town.No rthFo rk.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20 Single&Separate
Storm-Water Assessment Form
Contact:
Approved 20 Mail to:
Disapproved a/c
Phone:
Expiration 20
Building Inspector
Ir
1,
'pt PLICATION FOR BUILDING PERMIT
?n14 1,
Date , 20
_.m 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.
Qn, I W
(Signatu f applicant or nam of a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer general contractor, lectrician,plumber or builder
Name of owner of premises m igt-7 61.LC13 /'yD)9 N c Lk
(As on the tax roll or latest deed)
If applicant is a corp tion ' at e of duly authorized officer
(Name and tit of corporat icer)
Builders License No. 13ni-,RH l
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
a8'PS keatirN Bwp �C
House Number Street Hamlet
County Tax Map No. 1000 Section �� Block_ _Lot t ��
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
b. Intended use and occupancy , c
3. Nature 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 zoni g 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 Re,.voc)AacWtAeAddress 22ZSk6-&10A2 hone No.U "77-12517
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. s this property within 100 feet of a tidal wetland or a freshwater wetland? *YE NO
* YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE IRED.
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(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,A nt, 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 201L�_
CONNIE D.
Notary Public,Statea of of New York Q-C�
Notary Public No.OIBU6185050 g ture of Applicant
QuaNiled in Suffolk County
Commission Expires April 14,
Scott A. Russell , a°SU Ir STO]KIAWA\TEK
SUPERVISOR \NA\G]E1\\41ENT
SOUTHOLD TOWN HALL-P.O.Box 1179 ►
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of So u th o l d
CHAPTER 236 - STORMWATER MANAGEMENT-WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
-------------
DOFS THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
Yes NO (CHECK ALL THAT APPLY)
❑0 A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
E B. Excavation or filling involving more than 200 cubic yards-of material
within any parcel or any contiguous area.
El L C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
t
n[3/D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
El
EI/E. Site preparation within the .one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
❑0"'F. Installation of new -or resurfaced impervious surfaces of 1,000 square .
f
feet or more, unless prior approval of a Stormwater Management
I Control Plan was received by the Town and the proposal includes
' in-kind replacement of impervious surfaces.
If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building Department with your Building Permit Application.
------------------- -=-- ----- - - _—._ ..
S.C.T.M. 1000 Date
APPLICANT: (Property Owner,Design Professional,Agent, ontracto Other) ":
trim
qn-
NAME: T� YCoE CC t
w• Section Block Lot
Qnto- L
" Q * FOR BUILDING DEPARTMENT USE 0,-L'r
Contact Information � '—92!0 "5
Mkph rk..W) _
- — — — — — — — — — — — — — — — — — — Reviewed BygiJ A
ate:
Property Address / Location of Construction Work: — — — — — — — — Da — — — — — — —
Approved for processing Building Permit_
20612.191 d1kk"' Stormwater Management Control Plan Not Required.
— — — — — — — — — — — — — — — — —
mi6f_ftuo/n) f3L.uYJ Soe 1-rt-LL b Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
FORM # SMCP-TOS MAY 2014
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THE LOCATION OF WELLS,WATER SERVICE
dtf+SK 3:ttiePcrenk3til�S i yr9hYv'�cvvsaaat�ir,rtl..t�3s*:ts:tts i,rtl tounfl Ltr
LINES, SEPTIC TANKS AND CESSPOOLS
SHOWN HEREON ARE FIELD OBSERVA-
TIONS AND OR DATA OBTAINED PROM
OTHERS. il�pttr„„)A:evz'?•1,11:11.Clitvf
offic?of Water mill Wasiawohs
C:New York
State Ealteration ca edditon to this document is a violation of Semon 7209
a1the New vark state Education Lew. SURVEY OF: L,
Cern his ban l indicated th ed hereon pan run very to the person r whom n I�preparetl , ,f A n _/ ����w�-/
and ort his MMII di the Title Consent/,Govern mantel Agency and omit A t,41-�1” of
Institution listed hereon.and to the assignees of the lending institutions or subse-
W ant owners -
Copies of this document not bearing the prolessional's inked seal or embossed t
seal shall not(o dimension a valid true copy. N � I I�w ��1
7th offsets(or dimensions)shown hereon from structures o the property Fees are !7 1M' K
for a specific purpose and use and therefore are not intended to guide the erection of 1
fences,relanmp werts.pools,patios,planting areas,addition to buildings or any other
oonstrucnon.
The existence of right of ways and/or easements of record.if any,not shown are
not guaranteed ,�fG F> TE: I I 14 8 SCALE: I
CERTIFIED ONLY TO: y DE IN G.G
DESTII �G1AF
'wf tin �y LAND SttJtVEYOR
Ncai +�
By OA p0$ 73 W. rf ftP '.pt Oi t eadth SO
DESTIN G.GRAF N.Y.S.LIC No.50067 9 P ROCKY POI Nrr � gjl�'to1±3�ti0
TAX I.D.No. `� _ 2�_0 — 44.3L SION PHONE(516) aaz
JOEL DALY
GENERAL CONTRACTING INC.
A BETTER BUSINESS BUREAU ACCREDITED BUSINESS
PO BOX 343
205 BOISSEAU AVE
SOUTHOLD NY 11971
Email:JoelDalyHl@optonline.net
1631766 1223 OFFICE AND FAX
NAME: Bondarchuck
ADDRESS: 2825 Kerwin Blvd
CITY: Southold
STATE: NY 11971
PHONE: 477 1247 or 768 0345
Subject: Emergency Ramp
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