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38544-Z
rOFF Z f7tL tt Town of Southold Annex 9/22/2014 P.O.Box 1179 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37169 Date: 9/22/2014 THIS CERTIFIES that the building DECK Location of Property: 1200 Indian Neck Ln, Peconic, SCTM#: 473889 Sec/Block/Lot: 86.4-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 11/19/2013 pursuant to which Building Permit No. 38544 dated 12/3/2013 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: SIDE PORCH ALTERATION TO AN EXISTING SINGLE FAMILY RESIDENCE AS APPLIED FOR The certificate is issued to Rushforth-Worrell,Rachel (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED /� triKd Signa ure sx TOWN OF SOUTHOLD �x 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#: 38544 Date: 12/3/2013 Permission is hereby granted to: Rushforth-Worrell, Rachel 220 E 5th St New York, NY 10003 To: Construction of a deck addition as applied for. At premises located at: 1200 Indian Neck Ln, Peconic SCTM # 473889 Sec/Block/Lot# 86.-4-3 Pursuant to application dated 11/19/2013 and approved by the Building Inspector. To expire on 6/4/2015. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $259.60 CO -ALTERATION TO DWELLING $50.00 Total: $309.60 Building I pector NOV 18 '04 03:53PM SOUTHOLD BUILDING 631 765 9502 P.1 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 subntuitted 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. 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 ambitect or angimer responsible for the building. 6. Submit Plarnuing 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 propv7ty showing all property lines,streets,building and urwsual natural or topographic features. 2. A properly completed application and consort 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 I. Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25.00,Alterations to dwelling 525.00, Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- S 100.00 3. Copy of Certificate of Occupancy-S.25 4. Updated Certificate of Occupancy- $50.00 Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. New Construction:_ Old or Pm-existing Building: `� (check one) Location of Prot a C7U � PCS one)-, Location Pjz ' Hamlet Huuse No. Street Owner or Owners of Property: US Suffolk County Tax Map No 1000,Section r g(o Block L _Lot SubdivisionFiled TAp. Lot: Pennit No.-9 Date of ireApplicant:L—0 l) �I�T' �'0►L©�K'�'� ilealth Dept.Approval: 0\--)A _ Underwriters Approval: hJ 1 `� Planning Board Approval:_0\V"� Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applican Iat pF SO(/l�o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ F UNDATION 1ST [ ] ROUGH PLBG. [ ] OUNDATION 2ND [ ] INSULATION [ FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: .� DATE INSPECTOR �L o��OF SOUjyol � o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] 71NAL TION [ ] FRAMING / STRAPPING [ [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR INOU"TION PM N.Y. STATIC ENMZGY CODE NMI ADDrrioNAL coN=NTs • dw TOWN OF�OUTHOLD 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 www.northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined ,20� Contact: Approved ,20 Mail to: Disapproved a/c Phone: Expiration 120 _ D Building Inspector 1920 920 PPLICATION 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 a0joining premise�,.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�suance 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 name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises y S KM 9—,T Hyj &9-eLL- (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer deice- 4!9-V so R" P 12 5 (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 proposed work will be done: L2o D 11101 h-rJ t,3 tete--- 1ATj 6- PEC-dN L, (1, House Number Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision Filed Map No. Lot (Name) J k 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 6 t tJ Gr( L- 6-u AY& b. Intended use and occupancy �S l 6--(� Fah t t_Y J)vJ 6-511_1 N6 W1 E5�4 LAe,6i3:P DOC V- 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal E�K(sT Demolition Other Work eN LA-KG-e ew(d1--; 0�TC'i(sl Ai&so fL R,eyyn o VwV (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Ar Number of dwelling units on each floor t J A If garage, number of cars IJ 6-- 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 1Q A- 7. Dimensions of 2xisting structures, if any: Front ?jq• 5 / Rear '51 Jam ' Depth (p 3 • {o Height Number of Stories 2 00 Dimensions of same structure with alterations or additions: Front 00 CSN G-c Rear CVr Ar1GF- Depth W C+ift 1Gff-- Height N D Ca,tee- Number of Stories NU CMAII� 8. Dimensions of entire new construction: Front Rear Depth -ry— J E�?-cS-f Height Number of Stories W MTH aF N E.0 0 ekc t,,T Q '9�" .3`1 w t 09Z -C� �k(.ST) 9. Size of lot: Front (�©�C1 Rear L qD.d Depth 23 2• 2,8'-M 10. Date of Purchase 0 3 ,- 2-0('2-- Name of Former Owner 11. Zone or use district in which-premises are situated Rpt,O E�WP A 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 R&Ckte-RvS Fee-rLA 14. Names of Owner of premises 4'N"fZE `^J°� —Address I?,W l CA ok A-nr Phone No. SA '���0-5 Name of Architect Address Phone No Name of Contractor EN t R o 0 menK �c Address PO 66 Phone No. Z<3 4--7414 P cr-Cc N is n5-(c7 (s8 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. STATE OF NEW YORK) SS: COUNTY OF U'�--EJ-�w RG-4 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the 001`2 Ac;m 07- (Contractor, Z(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. SwomjtQ before me this I_ day of � p V P N\ 20J-2�_ Notary Public Signature of Applicant CONME D.BUNCH Notary Public,State of Nov York No.011 1MW ouaNnea in&dk*Cvxtj 1 CorrNn"W,Expkw AM 14,2 J > Tmolel Alit f ^r Environment East, Inc. 2885 Indian Neck Lane P.O. Box 197 Peconic,New York 11958-0197 631-734-7474 Fax: 631-734-5812 JAIL` 23 2014 I Concerning Permit#38544 Worrell Residence 1200 Indian Neck Lane, Peconic Please accept this revised plan and section that reflect the changes we have made to the kitchen porch for this residence. We have decreased the size of the attached porch. Thank-you, ,�,�,^ y0 gm^ 1 Chambers L "C"'ES OF N TOWN CODES A P P 107 AS RLQUiREU-A����� DATE:E: U FEE- RD NO-Fiii- EUL TNO 7 K P T'rl E 65-1802 8 A,';l 7 0, 4 F FOLLO'NING .i -;T-� 'N - TNTC)UN F01 AT F0 R 0 0 2. 910'!JGPFRAM!,�,i:,l 2XI0&2X12ACQ GIRDER NSULATION 1j.,1 BOLTED TO 4,0 ACO 2X12 ACQ LEDGER 4, FINIAL ' ..'S N TO MASONRY 5/4 DECKJN" BOLTED TO HS IFA ICY OR 74r BELOwcRADE. BE COIVAETF "; 0' ALL GOSLOPE Lj L � ;p,4lS-"RLJCT'l0\�' J 11, [T[T T �t REQUI-3EMENTS OF'Trll[�: CCIDES OFF NEWIf" UNLAWFUL 2X10016'OIC YORK STATE. NOT Fd-SP0!"lSl'D'i-E7 FOR "Ml HOUT CERTIFICATE DESIGN OR CONST'RIJ("TION ERRORS. GRAVEL OF OCCUPANCY SECTION OFF S T 011 M'Vv'Xri ER RJ. ANT TO CHAPTER 236 OF THE TOWN CODE. EXISTING WALL NO CHANGES TO RESIDENCE (141 lo IUX STING GE LAR f- 7 F" DO:)R ----- ONE VFIDUST- ------------------ cjql::J� f--r------------- -- --------- - ZA10 a 2X12 G THRU I-8AL_ WORRELL RESIDENCE nTCHEN PORCH 1/4"=l-V 11.14.13 EPMRONMENT EAST INC. II II II II I I II II - - - - - - - - - - - - - - — — — — — - - - - - - - - - - - - - - - - - - - - - - EXISTING _ _ _ _- - - - - - - - - - - - - - - - - - - - EXISTING RESIDENCE-NO CHANGES TING OR i 26 WORRELL RESIDENCE KITCHEN PORCH ' EXISTIN CELLAR ENVIRONMENT EAST INC. R I ' t'05 Ito 7L ——_— LINE OF EXIST.DECK L------------------------------ T - - r-- ----------- ------J . . a 14"WIDE STEP Fes, 61 ►--�.--i 3� 51a 5/4 DECKING 2X8 ACQ JOISTS 2x10 ACQ LEDGER @ 16" oc BOLTED TO HSE . 2-2X10 ACQ GIRDER SLOPE BOLTED TO 4X4 ACQ TO MASONRY FTG. TO 3'-0" BELOWiGRADE. GRAVEL SECTION SUR\/EY OF PROPERTY N SITUATE: PECONIC TOWN: 5OUTHOLD W E SUFFOLK COUNTY, NY SURVEYED 03-20-2012 S SUFFOLK GOUNIY TAX # 1000 - 86 - 4 - 3 CERTIFIED TO: ]Rachel Rushfm1h-Wornolll Merrill Lynch Home Loans Old Republic National Title IInsu¢ence Company �O �.Off•. 01, 0 - $CA nZ�� �0 O 02 z .® �® o r o � 0 . ®`�" Ogg v� �g NOTES: C.E� S"'� Yhathorized alt'—,1n or oddhlan to a suvey ==%%V204, op beorng a IVenaed land wrveyor§seal Is a iotatfon of seckbn r—k sutrc1rd—2,of the t�York Sat * Education - —�—�- WOOD FENGE h . only copies Pram khe algl al o hle eH ey orka�wltli an orlglral of the Itnd sl,r.,eyor'e 1 _ strnped I shall be wnsldared}e be valid true MONUMENT FOUND 7C A �.t w. ■ 'GertiFicagons Irdico'e hereon slynlfy that this emrey wu prepared In accordance with khe ex- HEDGE GSC ��� ist g Code of Practice for Land a rveys adopted by kl»New York Stake,� mklon of f'rofesslanl L.ad wrveyas. 5md cerklFcatl y shall run only ko the person for Wlom fhs survey Isgopvrepe�1d GRAPHIC SCALE 1"=30' 2SF 6Q A�� to 'R. tIredtuk on Is ed he eon ad O LA N D Sv w ti�a sl�ne�ai E e le ding Iretl ion oe IFlaa- tlons oro nok trvnsferdae to addltbnvl llstitutlore Area = 45x56 5q. Ft. Area = I.00aI Acrea JOHN C. EHLERS LAND SURVEYOR O 30 60 q0 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF:C:\UsersVohn\Dropbox\12\12-119.pro lIl1E✓Y16 I..ViI G