HomeMy WebLinkAbout39030-Z FQt, `" Town of Southold Annex 9/22/2014
1493 P.O. Box 1179
Ca -VE 54375 Main Road
y • -` Southold, New York 11971
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dol # .�a.,
CERTIFICATE OF OCCUPANCY
No: 37168 Date: 9/22/2014
THIS CERTIFIES that the building DECK
Location of Property: 1705 Village Ln, Mattituck,
SCTM #: 473889 Sec/Block/Lot: 107.-11-2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
7/2/2014 pursuant to which Building Permit No. 39030 dated 7/16/2014
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:
DECK ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Palmore, Tanya
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Aut ed ignat e
4�QSOFFntco� TOWN OF SOUTHOLD
��. BUILDING DEPARTMENT
ar TOWN CLERK'S OFFICE
y . 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#: 39030 Date: 7/16/2014
Permission is hereby granted to:
Palmore, Tanya
1705 Village Ln
PO BOX 1131
Mattituck, NY 11952
To: construct a deck addition to an existing single family dwelling as applied for
At premises located at:
1705 Village Ln, Mattituck
SCTM # 473889
Sec/Block/Lot# 107.-11-2
Pursuant to application dated 7/2/2014 and approved by the Building Inspector.
To expire on 1/15/2016.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $324.00
CO -ADDITION TO DWELLING $50.00
Total: $374.00
Building Inspector
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`.0000
Date. l (9 p
New Construction: �-7 Old or Pre-existing Building:
� (check onCe�)'
Location of Property: 1 U� V k' k��t� �� �"\Ci LSC' }1J�/ I 1 �1 j a
House No. " Street Hamlet
Owner or Owners of Property: \ C V-)yC l�ctt�W
Suffolk County Tax Map No 1000, Section I `� Block Lot d0
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
pplicant Si nature
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
I FOUNDATION I ST I "UGH PLUMBING
FOUNDATION 2ND ]/INSULATION
FRAMING / STRAPPING FINAL
FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION CAULKING
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REMTKS. cSo
Las
DATEC�� lkl"ll 9L INSPECTOR
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�pf SOUjyol
��OOUNi'I,N�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUG LUMBING
[ ] 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 INSPE ON REPORT DATE COMMENTS
n
FOUNDATION(1ST)
FOUNDATION PND) M
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ROUGH FRA,1 Mrq& H
PLUMBING r
INSULATION PER N.Y. •
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STATE ENERGY CODE
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FINAL
ADD Y'
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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)765-9502l Survey
SoutholdTown.NorthFork.net PERMIT NO. 3703Z,;Z,; 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/y
Disapproved a/coto\\
UNC,
__ CZ v,"uvP
Phone: ( —"- >g
Expiration � ,20�
Building Trispector
APPLICATION FOR BUILDING PERMIT
Date l o 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 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 forte issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold,Suffolk County,1 Yor and other applicable Laws,Ordinances or
Regulations,for the construction of buildings,additions,or alterations or r oval or demolition ein described.The
applicant agrees to comply with all applicable laws,ordinances,building housing code, d gul 'ons,and to admit
authorized inspectors on premises and in building for necessary inspections.
c c�A
(Signatu)of applicant or name, a corporation)
VV I(I
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises 1 0y C PCAV-nrJ1rC
(As on the tax roll or latest deed) \ I
If applicant is a corporation,signature of duly authorized officer
I �
(Name and title of corporate officer)
Builders License No. � J U11� „��
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Lo ation of land on which proposed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section c7 Block Lot C'
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
3. Nature of work(check which applicable):New Building Addition Iteration
Repair Removal Demolition Other Work 'b(,C:.K ,C o*�I Vi A-Y Lk-c t
Ps, (Description)
4. Estimated Cost W11 c'C c 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 :�
I `
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. N /A
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear 5'"a
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth C
Height Number of Stories
t
1
9. Size of lot:Front 1 00 Rear (��.�S`1 Depth '�U
10.Date of Purchase G {�l G� Name of Former Owner
11.Zone or use district in which premises are situated Qe i��''nfi
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
I rlUci V i\\Gc)e lu,L*
14.Names of Owner of premises Gt�1Vc �Li,Mcv� Address fvl(a�4 truck,LVy 1"6.)Phone No. S 1
Name of Architect Address Phone No
Name of Contractor `l.+.nMt V lcw: tio.-*4 Address 6N" L'..c Phone No.
N`! t t`i 3 t
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 NOS/
* 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 NEWYORK)
COUNTY OF S Ut i t
CA-VIUix 11 wo being duly sworn,deposes and says that(s)he is the applicant
(N e o individual signing contract)above named,
(S)He is the ( ".0iyy�--
(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.
Sworn A.pefore me this p I
---.day of U 20 }`t
of is Signature/Applicant
Applicant
EMILY J REEVE
NOTARY PUBLIC-STATE OF NEW YORK
No 01RE6059270
Qualified in Suffolk County
My Commission Expirss July 23, 2017
Scott A. Russell ��-°Sll � ST01KIMMAXIER
SUPERVISOR \4A\1NA\(G 1E1�[]ENT
z
SOUTHOLD TOWN HALL-P.O.Box 1179 d
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town wn of So u th o l d
0 I
CHAPTER 236 - STORMWATER MANAGEMENT.WORK SREF-,, '
am
( TO BE COMPLETED BY THE APPLICANT ) '
_.. ._-.._..
DOES THIS PRojECT INVOLVE ANY OF THE FOILOWI -- -
(CHECK ALL THAT APPLY)
Yes No
❑ A. Clearing, grubbing, grading or.atripping of land which affects more
than 5,000 square feet of ground surface.
n E(B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
Q[, C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑[ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
❑E(E. Site preparation within the -one-hundred year floodplain as depicted }
on FIRM Map of any watercourse.
El[9/F. Installation of new -or resurfaced impervious surfaces of 1,000 square .
feet or more, unless prior approval of a Stormwater Management
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.
, ateS.C.T.M. 1000
APPLICANT- (Property OwnerDesign Professional,Agent,Contractor,Other)
District
NAM ,
Section Block Lot
"' FOR BUILDING DEPARTINIENT L E O,NLY
Contact Information:
Mkph—NbM
Reviewed By:
— — — — — — — — — — — — — — — — — — Date: l —�
Property Address / Location of Construction Work: — — — — — — — — — — — — — — — — —
r `�!,v Approved for proce��ing Building Permit.
A1 ''7U
'( `-) I 1 I at � L Stormwater Management Control Plan Not Required.
,"\Q'�'Cl �, k/ 1"l _ ❑ Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
FORM " SMCP- TOS MAY 2014
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET f VILLAGE DIST. SUB. LOT
4
j
FORME k OWNER 4 N E ACR. 53 ?
S w TYPE OF BUILDING
RES. ,,, SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
T
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va
3 /1 ul
4,
3 11„5_)94 'aR 0 Sj, �,
NEW OM L4)q)1)3 'Bpj:kc-�q,)6,
57�HOW (ew,�(cs
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L AP P
FARM Acre Value Per
13103 0#2941?T in�(Qur& 0001 w1k-oc-L
Tillable I ?T434-701 0 (cessory 54J
Tillable 2
cm
Tillable 3
Woodland
Swampland FRONTAGE ON WATER
Brushland
FRONTAGE ON ROAD
House Plot DEPTH
BULKHEAD
Tota I DOCK
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REF ONLY: /000 - /O 7 -//- 002 SEC. JAI D X109 //x'34
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MA/N ROAD
(N Y\S 05)
SURVEY OF PROPERTY
.Situated at
TT/TZIC K Surveyed
AM
by
T014/N OF SOLI79OL,D Smith, Jung & Gillis
SUFFOLK COUNTY _dkr a 66
NEW YORK Professionol Land Surveyor
120 Medford Avenue
Scale: 1"=30" Potchogue, NY 11772
Phone.: 631-475-3192
Survey Certified To: AUT IVOS S`/OI'ViV V C'EFE.e
TA IV YA ✓. 76 VAP 0,'� V/,/.CAGE /yANO e
F/9EL/7Y AIA TIONAG T/TGE /NS Co #09 - 7 `SCiFf /G��D c��C 'OBE.2 Z4 /9�2
✓1DM0R6A1V Cy.4SE 6A/VK, A A_ AS f%GE"
Dates Surveyed: A11cuS7 7, 0009 /�ALMO,eE
/NE
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APPROVED A5
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DATE. B P
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r.� �fJ /0�s� i ��u General Notes:
,, 1 Alx/v 2i.zr�� i 1 Footings shall be placed on undisturbed soil.
sAC
,� a •� 2 Concrete 3000 P.S.I.
\, \ =�==- = f i- - - -=-- -- -' (3)All structural support members A.C.Q. structural grade
! i J (4) All connectors Simpson Z-MAX galvanized (G185).
OF Nfk, (5)All fasteners hot-dipped galvanized, epoxy-coated or
stainless steel. Size and number for Simpson connectors
F per the manufacturer's specifications.
ROBERT O'BRIEN P.E.
0527�R V� CONSULTINC3 ENOfNEER1N0 SERVICES
Main Road, Laurel, N.Y. 1194E3
TO THE BEST OF MY KNOWLEDGE,BELIEF AND PROFESSIONAL JUDGMENT, �Z_/K �� :f'V C ``M "' _7 t-77
-` - ---`---------" ""' THESE PLANS ARE IN COMPLIANCE WITH THE NEW YORK STATE RESIDENTIAL CODE DW N BG P yE < /' I "' ✓ f'
SCALE _ DRAWING NO. SHEET r
DATE �/� / J'� ��'�-�7 OF