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HomeMy WebLinkAbout37691-Z Town of Southold Annex 10/31/2014 P.O.Box 1179 t, 54375 Main Road Southold,New York 11971 L CERTIFICATE OF OCCUPANCY No: 37245 Date: 10/31/2014 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 425 Jacobs Ln, Southold, SCTM#: 473889 Sec/Block/Lot: 88.4-1.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 12/4/2012 pursuant to which Building Permit No. 37691 dated 12/14/2012 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 and existing unfinished room altered to bedroom for a Bed and Breakfast in an existing one familv dwellin�pplied for per ZBA Special Exc�tion#6627 SE dated 3/21/2013. The ZBA Special Exc�tion#6627 SE dated 3/21/2013 The certificate is issued to Toth,William A&Toth,Vicki (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-12-0052 12/10/2012 ELECTRICAL CERTIFICATE NO. 37691 8/22/2014 PLUMBERS CERTIFICATION DATED 5/10/2013 Shoreham Plumbing t rite Signat re TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY It 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#: 37691 Date: 12/14/2012 Permission is hereby granted to: Toth, William & Toth, Vicki 425 Jacobs Ln Southold, NY 11971 To: construct a deck addtion & alter an existing unfinished room to a bedroom as applied for At premises located at: 425 Jacobs Ln, Southold SCTM # 473889 Sec/Block/Lot# 88.-1-1.5 Pursuant to application dated 12/4/2012 and approved by the Building Inspector. To expire on 6/15/2014. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $579.20 CO -ALTERATION TO DWELLING $50.00 Total: $629.20 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). I 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 I. 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- $100.00 I Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy- Residential $15.00,Commercial $15.00 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: 405 \JQc U b Lane House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Lot !' i Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approvall(� QE:a Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted:$5-a- 00 Applicant Signature *pF SO�lyOlo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 CAI 45 Southold,NY 11971-0959 X � i0 roper.riche rt(a�town.southold.ny.us oCOUN,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Bill Toth Address: 425 Jacobs Ln City: Southold St: NY Zip: 11971 Building Permit#: 37691 Section: $8 Block: 1 Lot: 1.5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: home owner DBA: License No: SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor 1st Floor Pool New Renovation X 2nd Floor X Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 8 Ceiling Fixtures 1 HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors 1 Main Panel A/C Condenser Single Recpt 1 Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture 1 Pumps Transformer Appliances Dryer Recpt 1-30 Emergency Fixture Time Clocks Disconnect Switches 6 Twist Lock Exit Fixtures TVSS Other Equipment: 1-paddle fan, 1-exhaust fan Notes: Inspector Signature: ` Date: Aug 22 2013 81-Cert Electrical Compliance Form.xls rof��gf�fFUtMe �Co�. Town l call, 53005 Blain Road v.. + Y.O. Box t17U ��{ rcicithun+ (r,.tl / 'n` l4n Stnrtholti, Nc,.e York 11071-0959 131111 DIN(; I)I?VAR I A1FN'1 TOWN OF' SOILITtIOLD Dale: Ruilding Permit No. ��cQq � Owner: (please prim) 1'lutt)hct (please ptlilt) I certify that the soldetnscd in 11ic water smpply t;'Ystcn) colfl tins less thrtn 1%111 of P" Icad. (Milers Signature) Sworn to before n1e. this (l,ty o A Kann PagnMM y r9101.Of New'York (irr.ON d in Suft k County No.4"PANIslfft C.rnm facWns larch 26th,zo Notary Public, t 'ounly �� IRA HASPEL ARCHITECT, P.C. 59945 MAIN ROAD SouTHOLD,NY 11971 PHONE: (631)765-2075 FAX:(631)765-5715 CELL(516)398-8753 June 23,2014 Town of Southold Building Department Re: Permit No. 37691 Construct deck addition and alter an existing unfinished room to a bedroom Vicki and William Toth 425 Jacobs Lane Southold,NY 11971 To Whom It May Concern, Please be advised that the completed construction at the above referenced project meets or exceeds the requirements of the construction documents and code requirements for the framing, strapping and pier construction. If there are any questions please call. Thank you. Sincerely, ka Hl@wW Ira Haspel Ira Haspel—Architect PC _.._.J �I pf SO! c7 <6 (/l�,o� l TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] RO H PLUMBING [ ] FOUNDATION 2ND [ ] SOLATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION f [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE �- INSPECTOR FIELD INRVORr DATE COMMENTS FOUNDATION(1ST) � FOUNDATION(ZND) x �J ROUGH FRAYCM& H PLUMMING r , INSULATION PER N.Y. H STATE ENERGY CODE FINAL MMONAL COMMENTS 22 3 1kl4t- Com-- 61K-7 o LI JA 4Ca od 1c (51 r b 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. Check Septic Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Examined ( 20L,),_ Single& Separate Storm-Water Assessment Form Contact: Approved J 20 y Mail to: Disapproved a/c V/ Phone: Expiration G R ECW W 0 Building Inspector «4 APPLICATION FOR BUILDING PERMIT BLDG.DEPT. Date , 201 a— TOWN OF SOUTHOLD 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. Y��_A�' --- (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 D to n-�-Y�- Name of owner of premises U i LLl 7_6— h (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. Locati�pn`,o�ff and on whhi hproposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section Block Lot l� J— Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and inte Ll ^ed use and occupancy of proposed construction: a. Existing use and occupancy � CY b. Intended use and occupanc'-C lO -Q wl - n l s V I ej h0aam 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 - — QJ IM a- 8. Dimensions of entire new conlc�n: Front Rear Depth I� Height Number of Stories 0�6 e•d 0 Depth 9. Size of lot: Front 7�g 3 7 �� � Rear. ' 10. Date of Purchase (*>©b Name of Former Owner LOY'Q�MQA-R- P/1 Qlb 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NOA 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO 14. Names of Owner of premises I o Address Phone No. Name of Architect Address Phone No Name of Contractor Q n-- Address Phone No. 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO�� * IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OCIUf ��V --7-- 1 //cy/ / OM being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, CONNIE D.BUNCH Notary Public,State of New York (S)He is the �� No.OIB`Us66118500Qualified i,i A (Contractor, Agent, Corporate Officer, etc.) Commission Expires April 14,2t(A 4 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. Swornefore me this t day of 20 A16-7) R&jLf".� \ /Lt--D� Notary Public Signature of Applicant BOARD MEMBERS Of S10Southold Town Hall Leslie Kanes Weisman,Chairperson �� jiy� 53095 Main Road-P.O.Box 1179 Southold,NY 11971-0959 l 1�i Office Location: Gerard P.Goehringer cis ar Town Annex/First Floor,Capital One Bank George Horning0 54375 Main Road(at Youngs Avenue) Ken Schneider ��COUHTI Southold,NY 11971 RECEIVED http://southoldtown.northfork.net a: I j ZONING BOARD OF APPEALS MAR 2 8 2013 TOWN OF SOUTHOLD Q Tel.(631)765-1809-Fax(631)765-9064 SO hold Town Clerk FINDINGS,DELIBERATIONS AND DETERMINATION MEETING OF MARCH 21,2013 ZBA APPLICATION#:6627 SE APPLICANTS/OWNERS: Vicki Toth CTM: 1000-88-1-1.5 PROPERTY LOCATION: 425 Jacobs Lane,(corner Main Bayview Road)Southold,NY SEORA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further requirements under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated January 31,2013 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION: The relief, permit,or interpretation requested in this application is listed under the Minor Actions exempt list and is not subject to review under Chapter 268. BASIS OF APPLICATION: The applicants request a Special Exception pursuant to Article III, Section280- 13B, subsection 14 of the Zoning Code, to operate a Bed and Breakfast within their existing single-family dwelling, accessory and incidental to their residential occupancy under the Building Department's Certificate of Occupancy Z-28260 dated March 08., 2002. The proposed three bedrooms for lodging and serving of breakfast to the B & B casual, transient roomers was created through additions and alterations to the applicants' existing one family dwelling including the conversion of second floor habitable space under Building Permit No. 37691,dated Dec. 14, 2012.. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on March 7, 2013, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property and surrounding neighborhood, and other evidence, and upon review of the code requirements set forth pursuant to Article 111, Section 280-13B(14) to establish an Accessory Bed and Breakfast, the Board finds that the applicant complies with the requirements for the reasons noted below: 1. Vicki Toth, the applicant herein, is the owner of the property, located at 425 Jacobs Lane, Southold, NY. It is improved with a two story single family dwelling, and an accessory barn, as shown on the Page 2 of 3—March 21.2013 ZRA File#6627SE—'Toth sCCM#1 000-88-1-1.5 2. survey drawn by Joseph A. Ingegno, Land Surveyor, dated April 17, 2002, subsequently revised by hand by the owner to show proposed B&B parking areas. The owners/applicants will continue to occupy same as their principal residence while the three bedroom Accessory Bed and Breakfast facility is managed and operated. 3. The applicant's plans comply with the on-site parking requirements and provide for 5 parking spaces,two for the principal single-family use and one(1)for each of the Accessory Bed and Breakfast bedrooms,as shown by the owner on the survey submitted. 3. The applicant complies with the requirements of a dwelling unit as defined in Section 2804 of the Zoning Code, has been issued a valid CO dated March 8,2002,and also building permit,437691, dated Dec. 14,2012, for the conversion of an unfinished room into another bedroom. 4. The Accessory Bed and Breakfast,as applied for, is reasonable in relation to the AC District in which it is located,adjacent use districts, and nearby and adjacent residential uses. 5. The Special Exception is accessory to the principal use and will not prevent the orderly and reasonable use of adjacent properties. 6. This accessory will not prevent the orderly and reasonable uses proposed or existing in adjacent use districts. 7. No evidence has been submitted to show that the safety,health,welfare,comfort,convenience or the order of the town will not be adversely affected. The applicant will comply with all existing Town Codes in regard to the operation of a B&B. 8. This zoning use is authorized by the Zoning Code through the Zoning Board of Appeals as noted herein,and issuance of a Certificate of Occupancy from the Building Inspector is required by code before an Accessory use may be occupied. 9. No adverse conditions were found after considering items listed under Section 280-142 and 280-143 of the Zoning Code. 10. Submission of a Certificate of Compliance or similar document will be necessary for issuance by the Building Inspector certifying that the premises conforms to Chapter 280 of the Zoning Code for an Accessory Bed and Breakfast use. RESOLUTION OF THE BOARD: In considering all of the above factors, motion was offered by Member Horning, seconded by Member Goehringer,and duly carried to GRANT the Special Exception permit for an Accessory Bed and Breakfast, to be used only in conjunction with the applicants-owners residence, as applied for, as shown on the survey drawn by Joseph A. Ingegno, Land Surveyor, dated April 17, 2002, subsequently revised by the owner to show proposed B&B parking areas, and as shown on the floor plans dated April 20,2001 as prepared by Robert James Higgins,Architect, with owner revisions showing all proposed B&B and private areas located within the interior. SUBJECT TO THE FOLLOWING CONDITIONS: I. This Special Exception Permit requires an operating permit and inspection by a Code Enforcement Officer from the Building Department that must be renewed annually. That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued. This Special Exception permit cannot be transferred to new owners Page 3 of 3-March 21,2013 ZBA File k6627SE-Toth SCTMN 1000-88-1-1.5 Any violations of the conditions, occupancy or other requirements described herein, may require a public hearing before the Zoning Board of Appeals to review potential action to revoke the Special Exception permit as granted herein. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Vote of the Board: Ayes: Members: Weisman(Chairperson), Goehringer, Horning, Schneider. This Resolution was duly adopted (4-0). r. Leslie Kanes Weisman,Chairperson Approved for filing 04 /2013 Municity -~ Chronology of Events --Toth Bayview Farm B&B 2011 - 2020 - 88-1-1.5 _ 2013 - 2013-01-10 Set up File 2013-03-28 Received the Special Exception # 6627 for a B&B from the ZBA dated 03/21/2013. 2013-07-16 Spoke to Vicki and set an inspection. 2013-07-18 Fire Inspection - Passed - Cert given. Municity Page 1 of 1 QF SouryOl O Town Hall Annex Telephone(631)765-1802 54375 Main Road Hfvc(631)765-g50� P.O.Box 1179 G @ roger.richertiOwn.southo d.ny.us Southold,NY 11971-0959 �►Ol�� ``�O oUIVT'1, BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: 7 Date: Company Name: Name: License No.: Address: Phone No.: 151 Lp wo JOBSITE INFORMATION: (*Indicates required information) *Name: / ( t6 l *Address: 01ti� *Cross Street: a e��D *Phone No.: Permit No.: —](p Tax Map District: 1000 Section: Block:_�_ Lot: , *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is job ready for inspection: ES NO Rough In Final *Do you need a Temp Certificate: YES Temp Information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION �� � I N )"l 82-Request for Inspection Form Town of Southold - Chapter 236 - Stormwater Management SWPPP - Storm Water Pollution Prevention Plan Assessment Form GENERAL INFORMATION: (All Requested Information is Required for a Complete Application) APPLICANT(/WE: Owner-Agent-Conaukal-abntractor cr Other(Clmle OM) Property OWNER:(ff Different than Applicant) /V/ Address: rasa: Telsphens Fax M Telephone* Fax is i E-Mai: E-Mail: I Properly Address: Brief Description of Construction Activity,Proposed Structural BMPs,Sol S.0 7.M.Fk StabAntion BMPs,Project Scope and/or Sequence of Construction Activity i ra.ew a.eaoe awew Lee IProride Aeelsonar Pepea as Neatletl) "a of Contractor andlor Contact Person Responsible for krrplaments8on of SWPPP: I Tebphonatk Faxlk. ------------------------------------------------ E-Nag'. _..______________-._-___________.._.___.________E-Mail: _.-_----^__^----------------------.------- ___..__-------•------------------------------- Noma of Persons Responsible for installation 8 Maintenance of Erosion Control Practice: Address i Telephone0: Faxil --------------------------_____ _ ___ __. E-Mail: i Total Area of All Total Area of tend Cbr6rg Project Parcels: andforGround Diskxbence: --------------------------------------------- (8-VIA—) _________ _________________________________(8.F.fA—) (S.F.f A—) i Project Duration: StartErol -.--._-._..-------------..___-_-.._.-__-.,,--------- (Anticipated) Date. Date: E . ---_-_.______._...._______.._.............._ .____.---__-- i pamendCelu+dlr0ep) f VVIII this Project Disturbe five(5�orNoreAcresatQ Any One Time During the Proposed Development 7 Yes ----------------------------------------- ------ i If YES:Plane Answer tlaFollowingl _ _,_--_--_.,._.---____.____..___..--------------- a. Does the Applicant have a Qualified Inspector On � Q Staff To Conduct the Required Inspections? Yes No b. Does the SWPPP Indicate How Frequently the Site Q Q List the NAMES or description of all Potentially impeated Waterbodies am#w Wetlands: r Inspections will Occur and for What Period of Time? Yes No E c. Does the SWPPP Adequately Identify All Temporary ------------ and/or Q [� I. and/or Permanent Soil Stabalizallon Measures? Yes No , . . .... .. .... . d. Does the SWPPP Adequately Identify a Complete Q Q *­___*_­_1___'__1. . . . .. -._.. . _......._ .. . . ... . ... ... I ' ll .. ... ... .................. Project Phasing Plan 7 Yes No stows of rmpectad we e. Does the SWPPP Indicate Additional Site Specific Q Q tarbody:seg•TMDL,ao3(a}Lissa Impaired_) Practices that Nil be Utilized to Protect Water Quality? Yes No f. Has the Applicant Submitted aCom Completed DEC Notice Type of knpacted Waterbody (eg.Lake,Creek,Bay,Pond,Sound,Freshwater WaeWed.») Of Intent and SWPPP Acceptance Form for Review Q Q i by the Town of Southold? Yes No STATE:OF NFW YORK, COIJN'TY O .... .........`...........SS 1}tat I..........................V....G�'�1..............................being duly swom,deposes and says that lie/she is the applicant for Permit, (Name of individual signing Docwrant) And that he/she is the ......................................... . trto� .. a•... . .........................................................._...(OwnerconacCorp—to Officer. Owner and/or representative of the 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 herewith. Sworn to before me this; .........................�jG...............day of.............. ...........................,201... NotaryPublic: .......................................................................................... .... .....G.. L 1......... ........ ................. (Signalwe of ) SWPPP Assessment FORM: 03-12 � ELIZABETH A.NEVILLE,MMC �� Tbwn Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971Fax(631)765-6145 MARRIAGE OFFICER 'j'� Q`' Telephone(631)765-1800 RECORDS OF MANAGEMENT OFFICER southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office SEP 2 8 2012 DATED: September 28, 2012 BLDG.DEPT. TOWN OF SOUTHOLD RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4112 for a Cesspool/Septic Tank Construction Permit submitted by: Vicki Toth Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Final approval required from the Suffolk County Health Department Signature 11 Xloz— Dated SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK / /Residential @$10 or❑ Non-Residential @ $25 Septic Tank 0 or Cesspool IB" Application No. Permit No. Applicant Name: V/ e- rb'TI'f Applicant Mailing Address: p�J`' 017 / Brief description of Propsed Construction or Alteration: ote 1,150 )?'CG Location of Proposed Construction/Alteration: Owner of Property:_ / I L_k�1 `I"D7-t+- Owner Mailing Address: L+t)45 Property Address: n �tru d 16 k j Name and Telephone No.of Contact Person: C l r r_ — a��J Tax Map No.: Section: Block: l Lot: / S� Nearest Cross Street: a n V r NOTE: LOCATION MAP MUST BE SUBMI ED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEP MENT APPROVAL. 1 Siganture of Applicant Date Received by: from the desk of... First . Josh Smith Fr"- Empire Vice President - Investments SECURITIES, INC. E-mail: jsmith@1empire.com v( ,-/ Member NASD/SIPC 1393 Veterans Memorial Highway• Hauppauge• NY 11788-3000 tel: 631.979-0097 toll free: 800-645-5424 www.lempire.com I am Iamilior with the"STANDARDS FOR AP ROVAL SCDHS Ref. RIO- 12 - 0052 ANC CONSTRUCTION.OF SUBSURFACE SE GE 4Q DISPOSAL SYSTEMS FOR SINGLE FAMILY SNCES yQ and will abide by-the con'dilions set forth therein and on Me1rO S S9. permit to construct. .O . % FY 0?O ti F 40 The locations of wells and cesspools shown hereon are from field observallon and or from data obtained %ran others. • �' Therefore their locations and or existenc • �� n �L9 is not guaranteed. • I 1 4 i00 • � PROPOSED NEW SEPTIC SYSTEM '00• (6 BEDROOMS) I- 1500 gal\Fy/fn&kat SEPTIC TANK 4- LPs 8'I x 4 Deep with 3 sand �O' collar-(SWI 3,'above ground Water 1► 3- 8'I r 4' LPs exiting - add / 8'/ x 4' deep LP. X� Replace /000 gd septc lank CO ' LOT 3O `\ SEPTIC I MEASUREMENTS Sr u.3' 2e.3' New i ` \ l C% \� � A�p LP#►2 2e' 36' Eabli Y f d�'' LF#3 30.3' 2>,i' EAIbL �► \ , L.P#E4 42' 49' New q ' � F MAP OF PROPER Y `• �,o AT ' o BA YV/EW 17 TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 'e�• 1000 - 88 - 01- 1.5 Scale: 1" = 50' 9 d June 28, 2012 Oct. 23, 2012 (Septic Sys. Flna6 ELEVATIONS ARE REFERENCE TO THE FIVE EASTERN TOWNS T OGRAC a �El ' MA LLPVEAE'NTS NOT SHOWN WREON ' AREA = 2. 773 Acres. " AOV AL MV Trow OR AAAffM TO Tris SURVEY JS A VIOLA Tary 1��,,5; LIC: NO. 99618 q/ �p9 aF T?AE NAk'M' YORK STA TE FDUCA TION LAW. EXON Al 1'101 x'C1K�► ?z - St,�DIVISI�ON Z ALL CERT/F/CA TIONS LOT NUMBERS ARE REFERENCED TO P CONIC SURVEYORS PC. H EMM Aff VALO FM THS MAP AND COPIES THEREOF ONL Y IF 'MINOR SUBDIVISION DEERFIEL D FARM' 631) 765 - 3020 FJ/16.3/1 763 - 1797 SAID AMP OR COPIES B&A THE M&FRESSED SEAL OF THE SURVEYOR FILED IN THE OFFICE OF THE SUFFOLK p.0. BOX 909 WOW sAINNTt#! APPEARS HEREONL COUNTY CLERK ON MAR. 27, 200/ AS MAP NO. 10596 1230 TRAVELER ST71 12-214 SCDHS Ref. # R10- 12 - 0052 I am familiar with the STANDARDS FOR A PROVAL AND CONS rRUC TION.OF SUBSURFACE SEBA GE DISPOSAL SYS rE•MS FOR S1NGL E FA MIL Y �ESIDENCES tip's and will abide by Jhe conditions set forth they in and on the 1rO S S permit to construct. 930�Oy F 1oTO The locations of wells and cesspools ? shown hereon are from field observation and or from data obtained`from others. Therefore their locations and or existenc .�l is not guaranteed. r 1119, Ir 41 t� t 4q, sp. 6111 4� 4 PROPOSED NEW SEPTIC SYSTEM '00, *1 (6 BEDROOMS) 3 3 aCO 1- 1500 gal•py/Indrical SEPTIC TANK / py 4- LPs 8'0 x 4 Deep with 3' sand collar (SW) 3 'above ground Water Alp 1► yc� 3- 8'0 x 4' LPs exiting L / odd 1 8"0 4 deep P. A� Replace 1000 gal sepla tank 0, ., �'0 Cy y / LOT 30 SEPTIC SYSTEM �\ MEASUREMENTS ./ A 1 O ST 11.51 2A:3' n1w T LP#f 29' 45.5 Exist. lb C% , LP#Z 26' 3E' Exist. LP#3 30.5' 29' EWEL .� ,� /' \, LP#1 X32' 49 New C% .� S OLK COUP,(UEPAR_AA7r'4_C H- .TH SERVICES %� % / r' ♦�'�:i. CGN3STFUCTED WORKS FOR F • A SINGILC-FAIM LY RESIOEtJCE as a•. ; 0 . K h. '.Ret. Foto, o Z. o o S Z F ^EM* �;rncs i Lied vr,*40:0y(uti;i =ut tW8 6-radon 112M been �► 3� :.e:s!'2 s"C;t•ti:sfl by Mk Or rtment 0 mer 8:12rwes and W d 10 F ( c_LatWad"FORA MAXIMUM 6` FtEDROCMS. • >, _44-Z &...I . I Q% ' w � � MA"=W=M= ' ,oAt BA YVIEW TOWN OF SOU THOLD SUFFOLK COUNTY, N. Y. �• 1000 - 88 - 01- 15 Scale: 1" = 50' o �6 77 June 28, 2012 1�1 Oct. 23, 2012 (Septic. Sys. Final) � 1 s RECEIEL OVED • .�:�� -- S ARE TO L THEYFIVEN ASTERN TOWNS TOIPOGRA�H/C = MAPS_ ALL IMPROVEMENTS NOT SHOWN HEREOYs/ AREA = 2. 773 Acres. .: ... rh `� ANY ♦LTBRATIOIN OR ADM TION TO TMS S+LMgVEY /S A VIOLA ntOIN N0. 496/8 OF SECTION 7POs OF rnE NEW YORK S TA re EDUCA r10N LAW. EXCW T AS PW SECTM 7209 - SUff&W.WV 2. ALL cERTIFIcA rjoNs LOT NUMBERS ARE REFERENCED TO P CONIC SUR YORS P.C. s� OR Vco�P/ES OR TM 1 PI AAV SSCO SE THEREOtFiEo uRV F *MINOR SUBDIVISION DEERFIELD FARM' 631) 765 - 5020 FXP!631) 765 - 1797 OF FILED IN THE OFFICE OF THE SUFFOLK P.O. BOX 909 WhVSE MMTURE APPEARS HEREON COUNTY CLERK ON MAR. 27, 200/ 1230 AS MAP NO. 10596 SOUTHOLD,EN.Y. 11971 STREET 12-214 �*MST CREScheck Software Version 4.4.3 NJ( Compliance Certificate Project Title: Toth Residence Energy Code: 2010 New York Energy Conservation Construction Code Location: Suffolk County,New York Construction Type: Single Family Project Type: Addition/Alteration Heating Degree Days: 5750 Climate Zone: 4 Construction Site: Owner/Agent: Designer/Contractor: 425 Jacobs Lane William Toth Ira Haspel Southold,NY 11971 425 Jacobs Lane Ira Haspel ARchitectP.C. Southold,NY 11971 59945 Main Road Southold,NY 11971 516-398-8753 ihaspel@irahaspel.com Passes Compliance:1.3%Better Than Code Maximum UA:78 Your UA:77 The%Better or Worse Than Code index reflects how dose to compliance the house is based on code trade-off rues. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code horn. Gross •Assembly or or D•• Perimeter - Ceiling 1:Cathedral Ceiling 420 22.0 0.0 19 Wall 1:Wood Frame,16"o.c. 432 13.0 0.0 33 Window 1:Vinyl Frame:Double Pane 34 0.310 11 Floor 1:All-Wood JOlst/Tniss:Over Unconditioned Space 420 30.0 0.0 14 Compliance Statement: The proposed building design described here is consistet with the building plans,specifications,and other calculations submitted with the permit application.The proposed buildin .h9gpde'signed t meet the 2010 New York Energy Conservation Construction Code requirements in REScheck Version 4.4.3 and to c�wilh't" ,requirements listed in the REScheck Inspection Checklist. Name-Title S' tura j Date Project Title:Toth Residence Report date: 11/19/12 Data filename:C:\Documents and Settings\Kathy Haspel\My Documents\REScheck\Toth No.2.rck Page 1 of 1 s ,t9 i�S �J� SF f KC. t 3 W;nlr�o,1rala�2rn7C„ r�rex '�3•�? `,F s t i I Tw 1"4-,•--Z I - J- Z!, VIEA.sL I / CloSi✓7` I � � '�.�� �1r��.E'��[i, ! ,in4� eta Y12 FFrC.4„ S�;r�,tE ,T i l Y(��b,lir1•�� t � I R-'3 s __t, F df 5• I /.r co „. ¢ APPROVED AS O6 D � C,f- f r nr c� .y �� w F}1 $ 1�p • r �, EX;STr A"C- -�� x DAT"E l P: '�, -76 _ gym, V�n�.y� �tvA., c� �,. FEE. �' 7r.�BY—,. . . _ NOTIFY BUILDING DEr' 765-1902 S ANI 1O 4 fPNri rt--;l' f xiSf�^ FOLLOWING INSP-*C'rl()N'a: — 1, FOUNDATION •TV'V0 R�C°M_4,JE_D -t": c.•��c FOR POURED CGNCR_ _j 2: ROUGH•FRAMING, _-- STRAPPING, ELECTRICAL - 3: INSULATION . 3 4, FINAL•CONSTRUCTION & F!-ECT C'AF Ott ELECTRICAL MUST BE COMPI,EfiE FON C 0. INSPECTION PAU",PF E ALL CONSTRUCTION SHALL h-(=r_T THr" REQUIREMENTS OF THE COIMh; Cr= ',; YORK STATE, NOT �E rC, DESIGN OR CONSTRUCTION;L-NNOR'S. PLUMBING RET�',!Nl STORM WATER RUNOFF ALL PLUMBING WASTE LCC- 10 /V -.- PURSUANT 'rM CHAPTER 236 &WATER LINES NEED OF THE TOWN CODE. TESTING BEFORE COVERING —� PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE c*j CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 OF 1% LEAD. s �e -r- c -- r •�� Ir�.Fr'7-)� � o P,- 41 p p - ' 'sk �,. SCALE I/ ll- 1 0 M APPROVED BY: DRAWN BY w DATE: II(r 12 r. t 7 [ I 1., i'a1y DRAWING NUMBER /_ rI 01 Owe Zpo Cs.r Lcv- �9 !f I 10 s 10 t>iA 7 c F+wrn„c.or Ty PGS= V �.0(0 $jllaER SKI ST/NG- LUb2Jb Jots-r V"e.rt 2X8 4c C? c� O �XtST/NG ff�SE 2x8 r4cat Lear � � -� Db/6 LK/a N boIfed +o hese bol AC,`tI"t - 4x4Accp post GRADE P8 -4 TyP T 10IV HASp -�- �a F� e) 7jt!' SCALE: V hY'i#-S APPROVED BY: DRAWN BY WA T' C Al Eq i q � � DATE: ((rl/�Z t � DRAWING NUMBER i r f�-